Job Ref. No. JHIL050
Position: Care Manager (Field)
Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa. Jubilee Insurance 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, Jubilee is the number one insurer in East Africa with over 450,000 clients. Jubilee Insurance 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. For more information, visit www.JubileeInsurance.com
We currently have an
exciting career opportunity for Care Manager within Jubilee
Health Insurance Limited. The position holder will report
to the Assistant Manager, Care Management will
be based at Head Office in Nairobi.
Role Purpose
Care Management, visiting
patients at the various service providers, providing professional guidance on
policy matters where requested, ensuring comfort and assistance of patient by
the service provider, and communicating with providers, clients and brokers on
a timely basis for any rejections or relevant concerns
Main Responsibilities
- Obtaining
daily reports of admissions in the various service providers.
- Broker/customer
communications by communicating as necessary admission claim decisions on
a timely basis.
- Care
Management – Through due diligence, ensuring undertakings are issued in
line with the policy provisions. Likewise for declines, ensuring that the
decisions are accurate.
- Visiting
of patients at the various service providers, obtaining details of
patients to confirm that admitted members are the eligible policy holders/
dependents.
- Confirming
that the treatment the member is given is covered by the policy purchased.
- Ensuring
that the medical reports in the hospital are accurate and reflective of
what is provided to the insurer and confirm what the member understands or
communicates.
- Ensuring
proper care and treatment of patient within acceptable protocols without
wastage by member/ provider.
- Reviewing
medical pre-authorizations for compliance with applicable policy
guidelines and giving guidance to the other care management team on any
information collected during the visits to the hospitals.
- 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.
- Obtaining
medical information from providers with written correspondence if
necessary.
- Participating
in care management meetings.
- Checking
and confirming membership validity and benefits (from the scheme benefits
file).
- Handling
of coverage enquiries with brokers, providers, members etc.
- Vetting
and confirming validity of the service given by the service provider in
relation to the benefits covered, treatment given, adherence to provider
panel rules and cost of treatment.
- Obtaining
additional required information on claims from providers, brokers, or
clients.
- Liaising
with our underwriting section on scope of cover for various schemes.
- Assisting
in conducting provider audits wherever necessary.
- Client
presentations and member education on wise utilization & risk
management.
- Managing
the 24-hour emergency helpline.
Functional Skills
- Performance
reporting and management
- Health
Benefits Plan Management
- Intelligence
and Business Development skills
- Policy
Interpretation
- Customer
Service
Key Competencies
- Visionary
Leadership
- Market
Awareness
- Customer
Focus
- Continuous
Innovation
- Ownership
& Commitment
- Team
Spirit
Qualifications
- Degree/
Diploma holders preferably in clinical studies (nursing, clinical medicine)
- Basic
understanding of the concepts of insurance
- Proficient
in the use of Microsoft office suite and packages
How to Apply
If you are qualified and
seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job
Reference Number and Position by 22nd November
2022
Only shortlisted candidates will be contacted.