Purpose for the Job
To head the regional unit composed of several counties clustered together, linking Minet and all members covered under the Managed Medical Care medical schemes, ensuring that Service Providers in the region provide adequate service, to the satisfaction of both the member and the client.
Duties and Responsiblities
Managerial Roles and Responsibilities:
Leadership and management support to the regional staff.
Effective management of county scheme operations.
Build strong working relationships with key regional stakeholders.
Develop strong partnerships with medical service providers in the region.
Operational Roles and Responsibilities:
Manage the regional office administration function through the administrative assistant.
Coach, train and mentor regional staff on scheme operations, case management and customer service.
Ensure case management compliance via care managers.
Case management for high-cost service providers in the region with an aim of managing costs.
Resolve issues escalated by the care managers, training coordinators and customer service representatives in their counties.
Proactively identify cost saving measures as well as analyze high-cost claims in conformance with the authorization and verify and identify possible overcharging, unnecessary expenditure and errors and to rectify such occurrences.
Communicate relevant information to the member, including but not limited to scheme rules, benefit structure and alternative treatment options.
Prepare monthly management reports on activities within the region; customer service, service provider relations, case management, training, communication, personnel issues, positive highlights and challenges faced.
Any other duty as may be assigned by the supervisor
Key Result Areas
Customer Service
Policy guidance
Care options information
Discount negotiations/Cost Control
The ability to motivate and inspire the team to action
Medical guideline orientation
Key Competencies
Stakeholder Management
Case management
Benefit coordination
Conflict resolution
Knowledge And Skills Required
Communication skills
Detail oriented
Interpersonal skills
Negotiations skills
Leadership skills
Professional and Academic Qualifications
Degree preferably in a Health-related course e.g. Health Systems Management
Certificate of proficiency (COP) in Insurance
Apply via :
hr.minet.co.ke
