Vacancies at Madison Group Limited

Overall responsibility:

Care Management, handling Inpatient preauthorizations, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns. Doing proper case management by doing physical visits and virtual follow up of all admitted members.

Key Responsibilities

• Care Management – Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise, for declines, ensuring that the decisions are accurate and a correct interpretation of the policy
• Ensure appropriate Turnaround Time is adhered to in issuing approvals.
• Seeking medical clarifications including medical reports, copies of investigation reports
• Broker/customer relations by communicating all necessary admission claim decisions on a timely basis.
• Work with the claims team and coordinating on any information noted in the claims especially inpatient claims submitted in cases where further information provided changes the position undertaken previously on the claim.
• Reviewing medical pre-authorizations for compliance with applicable policy guidelines.
• Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
• Visiting/engaging admitted patients and ensuring they receive quality and cost-effective quality care
• Engaging providers on matters cost, discounts, pre-agreed rates, packages, fixed cost model
• Checking and confirming membership validity and benefits (from the scheme benefits file)
• Handling of coverage enquiries with brokers, providers, members etc.
• Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
• Obtaining additional required information on claims from providers, brokers or clients
• Ensure accurate information is captured in the system and have a zero-error rate in benefit adjudication of all cases
• Liaising with underwriting section on scope of cover for various schemes
• Liaising with provider relations section on matters pertaining to provider panel, customer complaints etc
• Client presentations and member education on wise utilization & risk management
• Support the care management team to ensure all the deliverables are met within the given turnaround time

Skills and Competencies Required

• Health Benefits Plan Management
• Policy Interpretation
• Customer Service and Focus
• Ownership & commitment
• Team Spirit
• Excellent communication
• Ability to multi-task
• Strong negotiation and decision-making skills

Knowledge & Experience

• At least 2 years’ case management experience in a medical insurance environment
• Demonstrated knowledge of managing admissions and discharges in a busy insurance company
• Demonstrated experience in engaging service providers and doctors and negotiating cost
• Demonstrated experience in case management reports, physical visits, virtual follow up of admitted cases

Academic and Professional Qualifications required

• Bachelor’s degree in nursing or clinical medicine
• At least two-year’s experience in a case management role.

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Overall Responsibility:

To pick all calls directed to the medical call center and assign them to the relevant people; and handle client complaints and queries in order to improve the efficiency of the care team.

Key Responsibilities

• Pick all the calls directed to the, Medical call centre both main and back-up line and handle the clients to their satisfaction.
• Respond to all Outpatient, Optical and dental preauthorization requests while adhering to schemes rules and provider rules
• Respond to potential/existing customer inquiries by providing and/or clarifying with the desired information.
• Inform clients and service providers by explaining procedures and answering questions through inbound calls.
• Resolves complaints by clarifying issues and exploring answers and alternative solutions, implementing solutions, and escalating unresolved complaints.
• Complaints management by proper escalation of client and service provider queries.
• Follow up for end to end resolution on all issues raised by both clients and providers.
• Ensure strict process compliance in line with the business lines objective.
• Maintain and improve quality results by adhering to standards and guidelines, recommending improved procedures.
• Pick insights from clients and provider feedback on product and process improvement, and report them to the relevant people in a timely manner.
• Generate reports on the various engagements and feedback collected

Skills and Competencies Required

• Health Benefits Plan Management
• Policy Interpretation
• Customer Service and Focus
• Ownership & commitment
• Team Spirit
• Excellent communication
• Ability to multi-task
• Strong negotiation and decision-making skills

Knowledge & Experience

• At least 2 years’ experience in a medical insurance call centre environment
• Demonstrated knowledge of handling calls and approvals
• Demonstrated experience in engaging clients, service providers and doctors
• Demonstrated experience in customer complaints management

Academic and Professional Qualifications required

• Bachelor’s degree in Clinical Medicine or Nursing
• At least two-year’s experience in a medical call center in a busy medical insurance.

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Overall Responsibility:

Underwriting, vetting, pricing, set-up, renewal, servicing and support, reporting, documentation and management of schemes, and handling of related queries from clients and intermediaries on existing schemes.

Key Responsibilities

• Prepare competitive quotations and dispatch the same within the recommended TAT’s.
• Ensure pricing rates are competitive enough to provide favorable loss ratio.
• Constant review of schemes loss ratio and provide proactive suggestions to aid in claims control.
• Client interactions – to be able to deal with our customers face to face as walk ins or when we visit clients
•  Investigation:
  • Recognize trends of issues and where other processes are going wrong and being proactive in recommending solutions.
  • Familiarize with system to note it’s extremes and what needs to be adjusted to suit market trends.
• Liaise with the underwriters, actuarial and business development teams to evaluate the products being sold and equally when designing new ones.
• Support in renewal process by reviewing and advising on renewal terms based on loss ratios and profitability index.
• Preparation of client utilization reports and various utility reports as requested for by the business.
• Increase Premium volume through organic growth by selling additional benefits and enhancement.
• Supervise service levels and benchmark our customer service standards against the market.
• Hold forte on behalf of the team members while they are away.

Skills and Competencies Required

• Health Benefits Plan Management
• Database Administration
• Customer Service
• Continuous Innovation
• Excellent communication and multi-tasking skills
• Market Awareness
• Policy Processing
• Team Player
• Presentation Skills
• People management skills of both external and internal partners
• Integrity and honesty

Knowledge & Experience

• At least 2 years of experience in Healthcare Underwriting or Actuarial.
• Demonstrated experience engaging intermediaries.
• Developing and implementing operational procedures and policies.

Academic and Professional Qualifications required

• Degree in Actuarial Science/Statistics or Business-Related field.
• Progress in insurance professional course (AIIK or ACII) will be an added advantage.