Your time is now to be your exceptional best at Old Mutual!
Job Description
KEY TASKS & RESPONSIBILITIES
Pre-authorize scheduled and emergency admissions within the defined guidelines.
Determine the appropriate parameters for admission i.e. initial authorized cost and expected length of stay
Negotiate professional fees as appropriate for each admission.
Conduct hospital visits for admitted clients within the major towns
Liaise with doctors on the day to day management of patients and obtain medical reports where indicated.
Ensure smooth discharge process and coordinate any necessary post-hospitalization or stepdown care.
Revise reserves after discharge of member.
Collect feedback from admitted clients on quality and level of service by the providers
Assist in verification and audit of inpatient claims prior to settlement
Maintain relevant reports on admissions
Promptly respond to queries from clients, intermediaries and providers
Liaise with underwriting section for development of new products or benefits
Proactively escalate any identified risks or risk events
Any other duty assigned by management
Skills & Competencies
Excellent communication and negotiation skills.
Excellent interpersonal relationship skills.
Extensive networking with SP and other medical insurers.
Excellent analytical and monitoring skills
Good decision making in benefit utilization management.
High level of integrity and honesty
Qualifications, Knowledge & Experience
Diploma/Bachelor in Nursing or Clinical Medicine
Any insurance certification e.g. COP is an added advantage
At least 2 years’ relevant experience within a health insurance
At least 2 years’ experience in a busy hospital setting
Responsibilities
Skills and Experience
Apply via :
oldmutual.wd3.myworkdayjobs.com
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