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Care Officer
CIC Insurance Company
Nairobi, KE
Full-time
Posted 5 days ago
Job Description
PURPOSE:
Responsible for care facilitation/cost containment and call centre reachability.
PRIMARY RESPONSIBILITIES:
• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
• Monitor cost, average length of stay on inpatient cases.
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
• Conduct Hospital visits whenever the insured members are hospitalized
• Respond to stakeholder inquiries on cases involving medical care management.
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
• Facilitate referrals and medical evacuations when need be.
• Monitor benefits utilization and share timely updates to the stakeholders.
• Prepare and share timely reports as may be guided.
Academic and Professional Requirements
• Minimum Qualification - Diploma in Nursing or Clinical Medicine
Experience Required:
Two years of relevant experience in Care Management, medical claims and call centre
Responsible for care facilitation/cost containment and call centre reachability.
PRIMARY RESPONSIBILITIES:
• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
• Monitor cost, average length of stay on inpatient cases.
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
• Conduct Hospital visits whenever the insured members are hospitalized
• Respond to stakeholder inquiries on cases involving medical care management.
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
• Facilitate referrals and medical evacuations when need be.
• Monitor benefits utilization and share timely updates to the stakeholders.
• Prepare and share timely reports as may be guided.
Academic and Professional Requirements
• Minimum Qualification - Diploma in Nursing or Clinical Medicine
Experience Required:
Two years of relevant experience in Care Management, medical claims and call centre
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