Overall Job purpose
Reporting to the care supervisor the role holder shall maintain constant contact with hospitals to ensure continuous well-being of all the stake-holders and handling of medical claims with efficiency and accuracy.
Nurse Job Responsibilities
Pre-authorise 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 24hr helpline.
Qualifications for the Nurse Job
Diploma in Nursing
Basic understanding of insurance concepts
1-2 years’ experience in case and claims management
Professional qualification in ACII, IIK is an added avantage
Technical Competencies
Registered Nurse with Nursing Council of Kenya
Knowledge of case management processes and procedures
Knowledge of insurance regulatory requirements and concepts
Proficient in use of Microsoft office suites and packages
Essential Competencies
Learning & Researching
Working with people
Applying Expertise and Technology
Delivering Results and Meeting customer expectations
Following instructions & Procedures
Adhering to principles and values

Apply via :

careers.britam.com