Title: Nursing Officer (Health
Division)
Reports to: Head of Health Division
Job Summary: The jobholder will be
responsible for Claims Processing, Hospitals undertakings and Visits, Customer
Care, credit vetting and control and bills reconciliation and approval as per
the company policy guidelines.
- Keying
of claims – both reimbursement and credit.
- Vetting
of claims, checking on what is payable and not payable, either due to the
nature of illness or mode of treatment or payment within the Kenya Medical
Practitioners & Dentist Board guidelines.
- Assisting
colleagues on interpreting and processing of claims i.e. ensuring
diagnosis is within medical insurance cover and diagnosis matches
treatment offered.
- Liaise
with doctors, brokers and clients at large for patient admissions.
- Advise
members on how best to utilize their benefits by recommending cheaper
facilities and cheaper options e.g. maternity packages, chronic management
facilities.
- Advising
doctors on referral of patients with chronic illness to cheaper
facilities.
- Capping/reviewing
of undertaking through advise through letters to providers where and when
necessary to avoid exceeded limits and hospitals/doctors taking
advantages.
- Sending
undertakings to providers within the timelines.
- Go
through pre-authorization forms and scrutinize forms especially for clear
diagnosis management and nature of treatment. Requesting for further
information/medical reports where treatment needs.
- Nurturing
a good relationship with doctors, hospitals, brokers and other service
providers.
- Patient
visits for psychological support and ensuring they are receiving proper
medical treatment.
- Updating
providers with current list of members covered, those who have exceeded
limits and not to access services.
- Arrange
for health talks / cover review and ways of reducing over usage for
clients.
- Come
up with a sufficient and efficient credit panel for our entire clientele.
- Ensure
all credit providers are kept in check and ensuring smooth relationship
between our credit panel and ourselves.
- Provider
reconciliation and liaise with brokers on where member accessed service
not authorized which needs to be paid to providers.
- Sending
invoices of exceeded limits to Brokers / Companies for payment.
If you meet the above minimum requirements, send your c.v to
henry@gakenya.com indicate the position applied for on the email subject line
so as to be received not later than 13th March, 2013.