Insurance
Company Deputy Claims Manager Job Vacancy in Kenya 2015
Position:
Deputy Claims Manager - Medical Department
Job
Ref.: JIC239806
Department: Medical Claims Department
Industry: Insurance
Location: Nairobi
The company was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937.
The company was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937.
It has
spread its sphere of influence throughout the region to become the largest
Composite insurer in East Africa, handling Life, Pensions, general and Medical
insurance. Today, it is the number one insurer in East Africa with over 450,000
clients.
The company
has a network of offices in Kenya, Uganda, Tanzania, Burundi and Mauritius. It
is the only ISO certified insurance group listed on the three East Africa stock
exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange
and Uganda Securities Exchange.
Its
regional offices are highly rated on leadership, quality and risk management
and have been awarded an AA- in Kenya and Uganda, and an A+ in Tanzania.
We currently have an exciting career opportunity for Deputy Claims Manager.
The post
holders will report to the Head of Claims and will be based in Nairobi.
Role Purpose: Claims and Care Management; Handling cost containment measures including Provider audits and discount negotiations with doctors/ providers and Client relations by managing the 24 hour help line and assisting in resolving non- routine clients queries arising from walk-in clients and on phone
Responsibilities
Role Purpose: Claims and Care Management; Handling cost containment measures including Provider audits and discount negotiations with doctors/ providers and Client relations by managing the 24 hour help line and assisting in resolving non- routine clients queries arising from walk-in clients and on phone
Responsibilities
- Reviewing/processing inpatient medical claims for compliance with applicable policy guidelines
- Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy
- Cost Management by negotiating with providers on discounts
- Coordinating care management team
- Handling of coverage enquiries with brokers, providers, members etc.
- Monitoring group’s credit and reimbursement claims processing status
- Advising management on any peculiarities noted in the claims from group providers
- Risk management by carrying out presentations, member education on wise utilization and fraud detection and reporting
- Assisting Regional offices in coordinating care for regional clients in Kenya;
- Providing technical support to the regions- assisting on non- routine claim queries and streamlining processes
Key
Deliverables
- Customer satisfaction
- Cost management (reduction)
- Service delivery within the TATs
Qualification
and Experience
Academic
Qualifications
- Degree/ Diploma holders preferably in clinical studies (nursing/clinical medicine)
Functional
Skills
- Good understanding of insurance and the market at large
- Adequate knowledge in I.T
- Knowledgeable in care management processes
- Performance reporting and management
- Health Benefits Plan Management
- Intelligence and Business Development skills
- Policy Interpretation
- Customer Service
Relevant
Experience
- At least 3 years relevant experience
Applications
Interested
and qualified candidates should send their application letter including an up
to date CV with 3 referees to quality2015jobs@gmail.com (The subject matter of
the application should be the Title and the Job Ref. of the job applied for)
If you are not interested in this opportunity today, please refer any friend or colleague you know that might suit the required profile.
Only shortlisted candidates will be contacted.
Please note that there are no fees charged for receiving or processing job applications.
If you are not interested in this opportunity today, please refer any friend or colleague you know that might suit the required profile.
Only shortlisted candidates will be contacted.
Please note that there are no fees charged for receiving or processing job applications.
Disclaimer
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advertising for the above Jobs.
Onus is upon the individual
(website visitor) to clarify the veracity or otherwise of each advertisement
before making an application
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