Latest Jobs at Britam

Job Purpose:

Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for effective management of the chronic disease program and wellness, coordinate wellness initiatives and health talks.

Key responsibilities:

• Enroll patient into disease management programs and coordinate their care plans.
• Post-discharge, follow up for hospitalized patients and coordinate home-based care.
• Coordinate wellness initiatives, health talks and health messaging.
• Analyze morbidity data and recommend appropriate preventive interventions.
• Actively collaborate with specialists, hospitals and other relevant stakeholders in advancement of preventive and promotive healthcare services.
• Strategic purchasing of preventive healthcare services.
• Monitor care processes for quality metrics and preparation of management reports.
• Provide strategic input during product development and benefit design process.
• Any other duties assigned by management.

Knowledge, experience and qualifications required:

• Bachelor of Science in Nursing (BSN).
• At least 3 years’ experience in a busy private hospital or clinic setting.
• Solid knowledge of preventive and promotive healthcare services.
• Experience running or coordinating a high-volume NCDs specialist clinic.
• Prior experience in a health insurance company is not required.

Technical/ Functional competencies:

• Excellent communication, negotiation and interpersonal skills.
• Excellent analytical and monitoring skills.
• High level of integrity and honesty.
• Team player, commitment and ownership.

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Job Purpose:

Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for effective provider management to enhance cost saving measures, customer engagement and provider relationship.

Key responsibilities:

• Review provider applications and contracts.
• Negotiate rates with providers in line with Britam Cost saving strategy. 
• Relationship Management of providers and ensuring they are reasonably satisfied with the company. 
• Update provider panel/Contacts to ensure the list is current and up to date. 
• Analysis of provider costs, claims, and provide data to inform decision making in scheme cost controls. 
• Ensuring all current and upcoming providers have signed contracts and have submitted all relevant documentation, carrying out system updates and filing of all relevant provider KYC documents. 
• Assist in carrying out country-wide provider audits to ensure that quality and cost-effective medical services are guaranteed for our clients. 
• Provide guidance to the care management team, claims team and contact center agents on provider issues.

Knowledge, experience and qualifications required:

• Diploma in Nursing/Clinical Medicine or any other related diploma.
• Good understanding of the concepts of medical insurance. 
• 2-4 years’ experience in provider management (Doctors and Hospitals).
• Proficient in the use of Microsoft office suite and packages.

Technical/ Functional competencies:

• Excellent communication, negotiation and interpersonal skills.
• Excellent analytical and monitoring skills.
• High level of integrity and honesty.
• Team player, commitment and ownership.
• Empathy and Customer Focus.
• Basic understanding of health insurance.

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Job Purpose:

Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

Key responsibilities:

• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Interact with clients and service providers to ensure that the care is given within policy guidelines.
• Review medical reports and claims for compliance with set guidelines.
• Liaise with underwriters on scope of cover for the various schemes.
• Ensure that medical scheme members are attended to round the clock with support from 24-hour call centre.
• Poly-Pharmacy - discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
• Generic substitution - Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Delegated Authority:  As per the approved Delegated Authority Matrix.
• Prepare periodic reports for management on medical claims.
• Ensure claims are processed within the stipulated time.
• Perform any other duties as may be assigned from time to time.

Knowledge, experience and qualifications required:

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Moderate understanding of insurance concepts.
• Professional qualification in FLMI, ACII and IIK.
• 5-8 years’ experience in case management two of which should be in a supervisory position.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.