The Assistant Consultant will ascertain seamless service delivery to clients by offering support and assistance to medical insurance policy holders through the claims & call centre and at medical facilities, with minimal inconvenience, while supporting the overall goal of client satisfaction.
This role reports to the Team Leader, Care Management.
In more detail, the areas of responsibility include:
Care Management
Receiving calls on the 24-hour medical emergencies help lines
Facilitate approval and authorization for Emergency Inpatient hospitalization e.g. post road traffic accidents from the insurance companies/underwriters.
Outpatient treatment authorization (off smart/ no card)
Facilitate evacuation processes to ensure favorable outcomes and reasonable charge to clients.
Preauthorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
Liaising with the Insurance companies in the process of undertaking and pre-authorizations.
Provider panel management – ensuring required facilities are onboarded and favorable relationship is always maintained.
Reporting
Provide data reports collected from various monitoring tools assigned to the role e.g. weekly and/or monthly reports.
Trend analysis – hospital charges, cost of various packages etc.
Value Adds
Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge.
Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers.
Issuing Zamara gift packs – pack of diapers, branded get well / birth congratulations to admitted patients.
Experience and personal qualities
A Diploma in Nursing Sciences/ Clinical medicine
Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
General understanding of the insurance industry is an added advantage.
Capacity to build relationships
Business etiquette
Excellent interpersonal and customer service skills
Team player
Problem Solving skills
Self-Driven
Flexible to train
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