Nurse at Britam

Job description

Job purpose

Maintaining constant contact with hospitals to ensure continuous well-being of all the stakeholders and handling of medical claims with efficiency and accuracy.

Key responsibilities

• Pre-authorize scheduled and non-scheduled admissions within the set guidelines
• Liaise with the hospitals and doctors for prompt submission of the admission summary form
• Monitor procedures being carried out on patients and see to the general well being of the patient
• Assess and authenticate inpatient and outpatient medical claim documents
• Revise reserves after discharge of a member
• Ensure smooth discharge process and co-ordinate any necessary post-hospitalization care
• Visit health care Institutions in the assigned region to confirm admissions.
• Prompt collection of claims paid out of policy liability
• Process reimbursements within the stipulated time
• Assist in carrying out verification and medical audit of claims invoices before settlement
• Handling of the 24 hour helpline.

Key Performance Measures

• % Claims turnaround time
• % customer complaints resolved within SLA
• # of customers engaged in awareness training
• Customer satisfaction index
• Net promoter score (Customers)

Knowledge, Experience And Qualifications Required

• Diploma in Nursing
• Basic understanding of insurance concepts
• 3.1-2 years’ experience in case and claims management
• Professional qualification in ACII, IIK is an added advantage.

Competencies

• Knowledge of insurance concepts
• Knowledge of case management processes and procedures
• Knowledge of insurance regulatory requirements

Core competencies

• Good Communication skills
• Building Relationships
• Focuses on the Customers
• Develops Self
• Solves Problems