PURPOSE OF THE JOB
Provide superior customer experience by efficiently and effectively managing clients and medical provider requests, queries and enquiries.
To process medical claims submitted to the company and determine whether claims meet eligibility standard of the company.
KEY RESPONSIBILITIES
Claims Processing
Confirmation of membership, validity, and benefits before processing claims.
Capture and vet medical bills within the client’s benefit structure and as per negotiated customary, reasonable rates.
Correctly reserve bills on discharge and approved outpatient cases.
Preparing and sending of the correct remittances to clients.
Case Management and Customer Service
Receive and respond to medical emergency lines and ensure 24-hour coverage.
Handle phone calls and visitors, as well as resolve customers’ communication through electronic and physical channels.
Issuance of both inpatient and outpatient approvals for admissible requests for insured members.
Communication and notification to stakeholders on management of cases, discharges, admissions, and financial liability
Coordinate with the clients and medical providers to leverage on NHIF.
Negotiation of doctors’ and hospital bills and charges with the aim of reducing the cost of care before or during admissions.
Weekly running and sending out active members list to preferred panel of providers.
Assist in coordinating local and international emergency evacuations, referrals, and transfers.
Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi.
Send weekly and monthly reports on admissions, exceptional claims, long stay, savings, claims production amongst others.
KNOWLEDGE AND EXPERIENCE
Qualifications:
Academic Qualifications
Bachelor’s degree Nursing/ Diploma in Nursing /
Clinical Medicine.
Professional Qualifications
Nursing Council of Kenya
Clinical officer Council
AIIK or Certificate of Proficiency will be an added advantage.
Experience
At least one year experience in health insurance
Knowledge
Understanding of insurance industry
SKILLS AND COMPETENCIES
Excellent communication and Interpersonal Skills.
Problem Solving
Empathy
Negotiation Skills
Ethical
Team Player
Planning & Organization Skills
Customer Oriented
Dependability
Applications with a detailed CV, indicating your telephone contacts with names and addresses of three referees should be emailed to careers@paciskenya.com not later than Thursday 14th September 2023.
Apply via :
careers@paciskenya.com
