Vacancies at Britam

Job Purpose:

Controlling and Managing policies through case management to ensure quality and cost effective care, client service, provider management, processing and payment of claims.

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.
• Discourage poly-pharmacy by diligently challenging of prescriptions and suggesting better alternatives as per medical practice.
• Encourage use of generics and cost effective quality drugs where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Review documents and pertinent requirements regarding claims from providers and clients.
• Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements of an insurance claim.
• Management of relationships with clients, intermediaries and service providers
• Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate risk.
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claims inquiries concerning claims process, service providers, and the filing/completion of proper forms.
• Record all claims transactions.
• Prepare claims registers for claims meetings and update the various claims reports.
• Track and follow up on receipt of necessary documents.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required:

• Degree in Bachelor of Science in Nursing Sciences from a recognized university.
• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least two-year experience in case management and claims processing.

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Job Purpose:

Reviewing proposal forms, verifying client’s data, assessing the proposed risk within set standards, counter checking the terms of the policy as well as reviewing the conditions of the policy

Key responsibilities:

• Assess the proposed risk within set standards.
• SLA management with the support functions (finance, IT, operations).
• Data collection and analysis.
• Risk Assessment and loss ratio rating.
• Review proposal forms.
• Release policy documents to clients.
• Communicate with clients on the renewal terms.
• Liaise with intermediaries, partners and direct clients on issues relating to their policies.
• Generate renewal notices for all renewal business.
• Keep detailed and accurate records of policies underwritten and decisions made.
• Maintain high standards of customer service - responding to clients enquiries; (walk-in clients, telephone and emails).
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required:

• Bachelors’ degree in Commerce, Insurance option.
• At least one year experience in claims processing.

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Job Purpose:

Controlling and Managing policies through case management to ensure quality and cost effective care., client service, processing and payment of EMC claims.

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.
• Review documents and pertinent requirements regarding claims from providers and clients.
• Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements of an insurance claim.
• Management of relationships with clients, intermediaries and service providers.
• Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate risk.
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claims inquiries concerning claims process, service providers, and the filing/completion of proper forms.
• Record all claims transactions.
• Prepare claims registers for claims meetings and update the various claims reports.
• Track and follow up on receipt of necessary documents.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required:

• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least one year experience in case management and claims processing.

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Job Purpose: 

Co-ordinate activities and support services within the Business Processing and compliance maintaining prompt, efficient and effective operational support.

Key responsibilities:

• Process all policies new and renewal as per SLA and within the set guidelines.
• Preparation of data upload files- Benefit set up and Member upload files and ensure set up of correct benefits for each corporate schemes and Retail policies.
• Process all claims from service providers, sort out invoices with reconciliations issues shared by finance (stuck invoices within the process, resubmissions).
• Process all reimbursements as per SLA.
• Process all endorsements as per SLA.
• System testing, validation and continuous innovation on processes and training of colleagues as required from time to time.
• Performing Quality assurance on captured claims ensuring reduced reconciliation challenges and that business does not suffer any loss from fraudulent claims.
• Ensure customer data quality and compliance is maintained across all operations as required.
• Schemes reconciliation and maintenance of client data – Data reconciliation for Renewals and New Business policies.
• Master policy creation and conversation for new retail policies.
• Processing of retail policies and advising finance on receipt and allocation of premiums for retail policies booked.
• Preparation and request of medical cards within set TAT and maintaining clear records on requested and issued cards to clients.
• Preparation and presentation of departmental and business reports – Daily and Monthly reports.
• Maintain regular internal (to staff) and external (to customers) communication on Customer Service matters implementing customer experience strategy for the company.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Score Card.

Knowledge, experience and qualifications required

• Bachelor’s degree in a business-related field.
• At least 4-6 years’ experience in a similar position
• Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
• Computer Literate; emphasis on Microsoft Office and EDMS.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Good communication and customer service skills.
• Should possess functional knowledge, be result oriented and have problem solving skills. 
• Consistency in adherence to the application of established policies, processes, procedures and tools in achieving compliance requirements, optimal efficiency, and resource utilization.
• Interpersonal skills to effectively communicate with and manage expectations (internal) and other stakeholders who impact performance.
• Self-empowerment to enable development of open communication, teamwork and trust that are needed to support performance and customer-service oriented culture.
• Ability to take initiative/responsibility to ensure that daily duties, routines and related additional tasks are completed timely.

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Job Purpose:

The role holder will be responsible for Accounts payable, Receipting, Reinsurance, Fixed assets, Taxation, Intercompany, bank and general ledger reconciliations. 

Key responsibilities:

• Perform monthly reconciliation for all debtor balances between the Line of Business system & ERP.
• Prepare monthly debtors report & ensure the debt is aged accordingly.
• Share uncollectable debt with the appointed debt collector. 
• Circulate debtor statements to intermediaries, sales & underwriting teams & resolve any matters that arise.
• Prepare demand letters for issuance to intermediaries & follow up on suspension & cancellation. 
• Perform regular account reconciliation with the relevant teams & ensure sign offs are done.
• Ensure all premiums received are receipted promptly.
• Ensure prompt and accurate payment of monthly & weekly commissions to intermediaries.
• Prepare regional, branch & unit managers override payment file every month.
• Prepare IFRS 17 debtor movement report quarterly.
• Review & ensure medical accruals are up to date.
• Ensure timely resolution of all intermediary queries.
• Timely & accurate processing and payment of premium refunds.
• Review & process incentives & admin fees payments.
• Prepare accurate weekly & monthly receipts reports.
• Respond to all auditor requests promptly.
• Attend the weekly credit control meetings & offer full support towards debt collection.
• Offer full support to the IT team on system enhancements & automation.

Key Performance Measures:

• As described in your Personal scorecard.

Knowledge, experience and qualifications required

• Bachelor's degree in a business related field.
• CPA(K) or other similarly recognized accounting profession qualification.
• 2-3 years of accounting experience in a similar role.
• Knowledge of ERP AP system and/or experience of using Oracle Financials would be an advantage.
• Strong  computer and business solutions software skills.
• Strong analytical and problem solving skills.
• Analytical skills.

Technical/ Functional competencies:

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

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Job purpose:

The role holder will be responsible for answering calls in a professional and informative manner and CRM case logging as necessary. Provide timely and appropriate responses to clients and/or assign tickets to the right person or department.

Key responsibilities:

• Handling customer queries, complaints, instructions received through call and email communication.
• Interact with clients, intermediaries  and service providers to ensure that the care is given within policy guidelines.
• Set the appropriate parameters for admission cases i.e. claim reserve, initial authorized cost, cover benefits  and duration.
• Respond to queries from clients, intermediaries and service providers through answering telephone calls, interviewing clients and verifying information. Liaise with underwriters on scope of cover for the various schemes benefits.
• Ensure that medical scheme members are attended to round the clock.
• Prepare periodic care reports for management on medical matters/ issues.
• Maintains and improves quality results by adhering to standards and guidelines while recommending improved procedures with a QA score target.
• Ensure clients outpatient approvals are issued via email as per SLA.
• Facilitate admissions and discharges appropriately.
• Maintains communication equipment by logging in interactions through CRM for traceability / visibility.
• Maintain and monitor telephone budget allocation to ensure lines are diverting to E1 lines.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Scorecard.

Knowledge, experience and qualifications required

• Degree/ Diploma in Nursing or related medical field.
• 3 - 5 years in a similar role. 
• Knowledge of insurance regulatory requirements.
• Knowledge of Britam products and services. 

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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.
• Prepare periodic reports for management on medical claims.
• Ensure claims are processed within the stipulated time.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Score Card.

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.

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Job Purpose: 

To effectively process medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement. This includes verifying submitted claims, assessing reimbursement policies, performing reconciliation with claims estimates, and conducting payment negotiations and providing support on the process of medical claims.

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.
• Poly-Pharmacy – discourage polypharmacy 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.
• Prepare periodic reports for management on medical claims.
• Ensure claims are processed within the stipulated time.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Score Card.

Knowledge, experience and qualifications required

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Moderate understanding of insurance concepts.
• 2-4 years’ experience in claims management position in a busy insurance environment or an insurance company.

Technical/ Functional competencies

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

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Job Purpose:

Providing assistance to the Assistant Manager Medical Underwriting in implementing the underwriting philosophy

Key Responsibilities:

• Implement underwriting philosophy, strategy, process and guidelines for medical insurance business to
  ensure profitability and achievement of the set loss ratio targets.
• Analyse proposed risks and make decisions to accept or reject.
• Determine the rates and terms to charge.
• Ensure risk survey recommendations are communicated in time and follow up implementation.
• Ensure underwriters comply to the company credit policy.
• Manage company records and ensure proper filing of client information both manual and electronic.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, Experience and Qualifications required:

• Bachelor’s degree (insurance option preferred).
• Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
• 2 years’ experience in medical.

Technical/ Functional competencies:

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

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Job Purpose:

Growth of medical insurance business to meet set annual premium targets.

Key responsibilities:

• Secure new business directly or through intermediaries in all the business channels.
• Maintain excellent customer service to intermediaries and clients.
• Service existing business.
• Follow up on renewals for medical insurance business.
• Forward proposal forms and all KYC documents to underwriting department.
• Ensure timely collections of premium as per the credit control policy.
• Prepare weekly reports as required by the BDM Corporate health.
• Undertake initial underwriting in accordance with set guidelines to ensure sound acceptance of risk.
• Respond to customer and client enquiries.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience, and qualifications required:

• Bachelors’ degree in a business-related field.
• Professional qualification in Insurance (ACII, IIK) will be an added advantage.
• 2 years’ relevant experience in the insurance industry.

Technical/ Functional competencies:

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