Fresh Jobs at PACIS Insurance

JOB PURPOSE

Collaborate with medical clients, intermediaries, and medical service providers to facilitate access to quality, timely, effective, and cost-efficient healthcare services with the aim of achieving business growth, profitability, and customer retention.

PRINCIPAL ACCOUNTABILITIES

Claims Processing:

• Confirmation of membership, validity, and benefits before processing claims.
• Capture and vet medical bills within the client’s benefit
• structure and as per negotiated customary, reasonable rates.
• Correctly reserve inpatient bills on discharge and approved outpatient cases.
• Preparing and sending the correct reimbursement remittances to clients.
• Communicating any claim dispute or rejection to the clients and intermediaries.

Case Management and Customer Service:

• Receive and respond to medical emergency lines and ensure 24-hour coverage.
• Issuance of both inpatient and outpatient approvals for admissible requests for insured members.
• Communication and notification to stakeholders on management of cases, discharges, admissions, and financial liability
• Coordinate with the clients and medical providers to leverage on SHA rebates and packages.
• Negotiation of hospital and doctors’ charges with the aim of optimal cost containment before or during admissions.
• Weekly running and sending out active members list to preferred panel of providers. 
• Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi.
• Resolve all customer queries immediately and promptly escalate complex cases
• Send weekly and monthly reports on admissions, exceptional claims, long stay, savings, claims production amongst others.

Qualifications:

Minimum Academic Qualification:

• Bachelor's degree Nursing/ Diploma in Nursing /Clinical Medicine

Professional Qualifications

• Nursing Council of Kenya
• AIIK or Certificate of Proficiency -Insurance

Experience:

• One year’s experience in health insurance 

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JOB PURPOSE

The jobholder is responsible for the assessment and determining terms for medical risks.

PRINCIPAL ACCOUNTABILITIES

Underwriting Role:

• Assess the new and existing risks and ensure that they are adequately rated and commensurate with the terms and conditions advised and endorsed to retain profitability of the medical portfolio.
• Provide competitive quotations to all customers promptly within the standards set.
• Membership management; additions and cancellations.
• Scheme set up, benefits set up and membership updates in the system
• Timely and accurate debiting of premium and cover conditions and that the documentation is in compliance with set standards and procedures.
• Ensure that medical insurance cards are issued in an efficient timely and accurate manner
• Prepare and send renewal notice within stipulated timeline and co-ordinate follow up of the renewals to achieve renewal targets.
• Ensure policy endorsements & documents are accurate and made within the standards of service, and ensure timely dispatch
• Train various stakeholders on company products for increased knowledge and growth of business
• Monitor scheme loss ratios and adjust renewal terms accordingly
• Assist with business acquisition through follow up on quotes and intermediary visits.
• Ensure business is booked as per the company’s credit policy and follow up on payment plans. 

Customer Service

• Continuously monitor the outpatient fund and check on prudent utilization of cover reporting any anomaly noted and ensure timely invoicing for top up.
• Provide benefit utilization reports as per the standards of service set out in the customer charter
• Provide timely feedback to client’s queries and concern as per service charter provisions.
• Maintain client and intermediary relationships through visits

Qualifications:
Minimum Academic Qualification:

• Bachelor’s degree in Actuarial science/Statistics from a recognized University.

Experience:

• Entry Level to 6 months of experience

Knowledge:

• Understanding of insurance industry

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JOB PURPOSE

To evaluate medical claims submitted to the company and determine whether claims meet eligibility standard of the company. • Reconcile provider statements and schedule their payments

PRINCIPAL ACCOUNTABILITIES

• Claims Processing and Provider Reconciliation:
• Receiving invoices form various service providers and registering them into system.
• Verifying and auditing all medical claims to ensure supporting documents are attached and following up of documents not submitted with service providers/clients.
• Accurate capturing of all invoices in the system.
• Prompt account reconciliation and sign offs with service providers and address all disputes to completion.
• Recommend appropriate payment of disputed billing as necessary
• Negotiate and schedule monthly medical payments for approval.
• Prepare and send payment remittances
• Prepare monthly claims, reconciliation and sign off reports for the management

Customer Service:

• Respond to client’s queries on telephone, calls, emails and walk in clients.
• Build and enhance relationship with providers to ensure Pacis
• Insurance account with the providers is current and active.
• Ensure adherence to contracts and service level agreements between providers and the company

Qualifications:
Minimum Academic Qualification:

• Degree in Business related course / Statistics/ Accounts

Professional Qualifications

• Diploma in Insurance IIK as an added advantage

Experience:

• 1 year experience in claims section of a health insurance department

Knowledge:

• Understanding of insurance industry 

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JOB PURPOSE

To grow the medical insurance book through expansion of the bancassurance channel through recruitment of BSOs and new banks through strategic relationship management ,negotiate binders and Financing models.

PRINCIPAL ACCOUNTABILITIES

Revenue Growth and Profitability:

• Drive revenue growth by optimizing existing partnerships and establishing new strategic alliances with banking institutions.
• Develop and execute the bancassurance channel strategy aligned with overall business objectives.
• Recruit dedicated Bancassurance Sales Officers (BSOs) to drive product penetration, customer acquisition, and revenue growth with banking institutions.
• Performance tracking for BSOs to ensure consistent meeting and exceeding of the sales targets.
• Design and implement initiatives to expand bancassurance, including new products, distribution models, and digital capabilities.
• Take full responsibility for managing tender requests from the channel and the quotation process, ensuring turnaround times (TATs) are consistently met to establish and maintain a healthy pipeline.
• Leverage data analytics to generate insights and drive uptake of relevant insurance solutions.
• Oversee effective lead generation, conversion, and customer onboarding processes.
• Provide ease of doing business tools for the retail and SME products to empower bancassurance officers to quote and bind business in the field with minimal reference to Pacis in line with the underwriting guidelines.
• Liaise with credit control team to provide statements on a monthly basis and ensure adherence to the credit policy.
• Manage agreements with intermediaries and ensure consistent compliance by all parties
• Develop and execute marketing campaigns to promote insurance products through bancassurance
• Use strong negotiation skills, to ensure that the appropriate targets, pricing, and margins are secured for all business development opportunities.
• Collaborating with Management on topline goals, planning, forecasting, and maintaining short and long – term business development plans in line with the medical business strategy.
• Prepare monthly and weekly business development reports detailing initiatives, performance, and other related projects/activities.
• Ensure compliance with regulatory requirements, industry standards, and TCF principles while providing leadership and fostering a high-performance, innovative team culture.

Relationship Management

• Continuously monitor the outpatient fund and check on prudent Establish and maintain professional relationships through networking with banking institutions
• Host regular and relevant functions (as agreed with line management) to seek opportunities to develop strong relationships and business bonds.
• Share submissions and hit ratios on a quarterly basis to make them aware of positive or negative trends.
• Implement a structured intermediary visit plan and maintain regular visit reports to track engagement, opportunities, and outcomes.
• Develop and execute a structured training plan for banking institutions to enhance product knowledge, sales capability, and overall performance.

Market Intelligence

• Collect market intelligence through research by reading articles, publications, internet, word of mouth and networking daily to keep abreast of market developments.
• Assess market opportunities with respect to competitor sales sources by remaining in touch with market forces and influences.

Qualifications:
Minimum Academic Qualification:

• Bachelor’s degree in Business related course (Insurance Option, Marketing, Business administration and Finance) or equivalent from recognized university.

Professional Qualifications

• Professional qualification - AIIK, ACII

Experience:

• Five (5) years ‘Insurance experience with at least two (2) years in medical sales within the bancassurance sector.

Knowledge:

• Understanding of insurance industry