Vacancies at Jubilee Insurance

Job Ref. No: JHIL163

Role Purpose

The Case Manager will be responsible for monitoring and managing the utilization of medical services to ensure appropriate and cost-effective care while maintaining quality standards; Conduct clinical reviews of cases, assess treatment efficacy, ensure adherence to best practices, and recommend adjustments when needed.

Key Responsibilities

• Execute robust case management strategies aligned with the organization's mission and objectives.
• Identify opportunities for innovative interventions, process enhancements, and costeffective healthcare solutions.
• Stay updated with industry trends, healthcare practices, and regulatory changes to inform strategic decision-making.
• Monitor, analyse, and report on case management outcomes to drive continuous improvement.
• Advocate on behalf of policyholders to ensure they receive necessary and appropriate healthcare services.
• Address any barriers to care, such as communication issues or insurance-related concerns.
• Maintain detailed and accurate records of assessments, care plans, and interactions with policyholders and healthcare providers.
• Monitor the quality of healthcare services provided to policyholders.
• Identify opportunities for improvement and work with healthcare providers to enhance care quality.
• Work to manage healthcare costs by ensuring that care is appropriate, cost-effective, and aligned with policy coverage.
• Evaluate active insurance cases to understand policy coverage, claim status, and the specific needs and concerns of policyholders.
• Negotiation and Settlement; Engage in negotiation with medical providers to achieve equitable settlements of hospital bills when required.
• Ensure strict compliance with healthcare regulations, insurance guidelines, and ethical standards within the Case Management function.
• Collaborate with legal and compliance teams to address complex regulatory and legal issues related to case management.
• Ensure all case management activities adhere to healthcare regulations, insurance policies, and ethical standards.

Key Skills and Competencies

• Exceptional leadership and team management skills.
• Strong analytical and critical-thinking abilities.
• Effective communication and interpersonal skills.
• Strategic vision and decision-making prowess.
• Thorough understanding of healthcare regulations and insurance practices.
• Clinical knowledge and medical expertise.

Academic & Professional Qualifications

• Bachelor's degree in nursing or clinical medicine, or a related field.
• Relevant certifications in case management, healthcare management, or clinical specialties.

Relevant Experience

• A minimum of two (2) years relevant working experience. Ideal candidates should possess a strong understanding of Medical Insurance.

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Job Ref. No: JHIL164

Role Purpose

• The Senior Wellness Coordinator, Population Health will be responsible for designing, implementing, and evaluating population health programs and initiatives aimed at improving the health outcomes of our target populations.

Key Responsibilities

• Design, monitor and report on the implementation of scheme-wise disease-specific interventions for communicable and non-communicable disease.
• Develop Monitoring population health profiles for all schemes and recommend appropriate control measures.
• Advise on population health initiatives and care delivery innovations to reduce cost and variations.
• Develop guidelines, tools, and indicators for effective disease surveillance at scheme level.
• Analyze, systematize, and disseminate wellness program-specific data to support development of Wellness Departmental reports.
• Support the wellness manager to develop, plan, and implement programs to support quality improvement strategies, disease management programs, population health initiatives, and care coordination through the continuum of care.
• Identify key cost-drivers and develop plans and strategies to inform care navigation.
• Assess and report on the impact of wellness technical activities and programs, within the context of wellness initiatives and active case management.
• Conduct, in collaboration with other team members, real-time analysis of disease trends based on claims data and advise on appropriate interventions.
• Liaise and collaborate with other relevant primary healthcare and other stakeholders in the public, non-government and private sectors, as well as consumers, in relation to the coordination of care of clients and population health interventions.
• Cultural Development: Foster a culture of empathy, excellence, and ethical conduct within the care navigation section.
• Quality Improvement: Drive continuous improvement initiatives to enhance the effectiveness of care navigation services and improve client outcomes.
• Uphold high ethical standards in all interactions with clients, healthcare providers, and colleagues.
• Stay informed about healthcare laws and regulations, including those related to insurance and privacy.
• Ensure that all care navigation activities are compliant with these regulations.
• Maintain accurate and complete records of all client interactions and care plans.
• Be transparent with clients about the services offered, potential limitations, and any fees or charges associated with care navigation services.
• Safeguard the confidentiality of client information and adhere to strict privacy policies.
• Seek proper authorization before disclosing any client information.
• Identify potential risks associated with care navigation activities and work with relevant departments to mitigate those risks.

Key Skills and Competencies

• Performance reporting and management
• Health Benefits Plan Management
• Intelligence and Business Development skills
• Policy Interpretation
• Customer Service

Academic & Professional Qualifications

• Degree/ Diploma holders in Public Health
• At least 2 years’ experience in a clinical setting
• Basic understanding of the concepts of insurance
• Proficient in the use of Microsoft office suite and packages

 Relevant Experience

• A minimum of two (2) years relevant working experience. Ideal candidates should possess a strong understanding of Medical Insurance.