Vacancies at CIC Insurance

PURPOSE:

Responsible for care facilitation/cost containment and call centre reachability.

PRIMARY RESPONSIBILITIES:

• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
• Monitor cost, average length of stay on inpatient cases.
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
• Conduct Hospital visits whenever the insured members are hospitalized
• Respond to stakeholder inquiries on cases involving medical care management.
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
• Facilitate referrals and medical evacuations when need be.
• Monitor benefits utilization and share timely updates to the stakeholders.
• Prepare and share timely reports as may be guided.

Key Skills, Knowledge, Experience and Behavioural Competencies
Academic and Professional Requirements

• Education    Minimum Qualification – Diploma in Nursing or Clinical Medicine

Experience Required:

 Description    Required years of experience

• Relevant experience in Care Management, medical claims and call centre    2

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PURPOSE:

To provide general customer service in respect to medical business customers.

PRIMARY RESPONSIBILITIES:

• Receive and respond to Medical Emergency lines and ensure 24-hour coverage of the Call Centre.
• Handle phone calls and visitors, as well as resolve customers’ communication through electronic and physical channels.
• Issuance of both in and outpatient approvals for admissible requests for insured members.
• Communication to stakeholders on management of cases and financial liability through reports.
• Provide input for the customer service reports.
• Share daily/weekly and monthly reports as may be required from time to time.
• Participate in cost management initiatives/strategies that have been put in place by the business.
• Handle customer service issues and queries in a timely manner.
• Escalate Customer queries to the relevant job role if necessary.
• Maintain professional ambience within the office premises.
• Promote the organization’s customer service charter.

Key Skills, Knowledge, Experience and Behavioral Competencies
Academic and Professional Requirements

Education    Minimum Qualification    Diploma in Clinical Medicine/Nursing (KRCHN)     

• Customer Experience training will be an added advantage.     

Experience Required:

 Description    Required years of experience

• Relevant experience in busy health environment    3
• Experience in a medical call centre management unit    1