Purpose for the Job
To support the clinical functions in the division by reviewing all preauthorization requests with the relevant medical teams, engaging with Medical Officers within medical facilities for any disputed cases, and supervising Quality Assurance of the medical functions (Pre-authorization and Claims) with a view to enhanced Customer Experience.
Duties and Responsiblities
Operational Roles and Responsibilities
To adhere to the set protocols and matrix of management of preauthorization requests.
Ensure next level management of disputed medical cases – i.e. communication to the satisfaction of the member.
Supervise the Quality Assurance team that provides oversight over the Preauthorization and Claims functions.
Thought Leadership through insightful articles.
Preparation of adequate packages and price lists for service provider contracts.
Continuous training and upskilling of the pre-authorization and claims personnel within the division.
Any other duties as may be assigned by the supervisor.
Key Result Areas
The accountability areas are as follows:
Positive Customer Experience
Enhanced Quality of Service
Policy guidance
Care options information
Discount negotiations/Cost Control
Key Competencies
Benefit coordination
Conflict resolution
Knowledge And Skills Required
At least 5 years’ experience in relevant field
Communication skills
Detail oriented
Interpersonal skills
Negotiations skills
Leadership skills
Professional and Academic Qualifications
Bachelor of Medicine and Bachelor of Surgery
A Masters degree in a medical field
Registration with the KMDPB
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Apply via :
hr.minet.co.ke
