Vacancies at Britam

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.
• Analyze 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).
• 2-4 years’ experience in medical.

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Job Purpose:    

• Co-ordinate activities and support services within the Business Processing and compliance operations 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.
• Maintain regular internal (to staff) and external (to customers) communication on Customer Service matters implementing customer experience strategy for the company.
• Perform any other duties as may be assigned from time to time.

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 3-4 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:

• Control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

Key responsibilities:

• Ensure all received claims are vetted and released to finance on time (Credit and reimbursement claims).
• Set the appropriate parameters for each admission and claims for IP and OP (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 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.