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Medical Care Associate Job, Insurance Jobs March,

 Medical Care Associate – Mombasa

Job Purpose

The role holder will be responsible for controls and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care within Mombasa region.

Key responsibilities

  • Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
  • Interact with clients and service providers to ensure that the care is given within policy guidelines
  • Review medical reports and claims for compliance with set guidelines
  • Liaise with underwriters on scope of cover for the various schemes
  • Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
  • Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
  • Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
  • Prepare periodic reports for management on medical claims
  • Ensure claims are processed within the stipulated time
  • Delegated Authority: As per the approved Delegated Authority Matrix.

Qualifications

  • Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
  • Moderate understanding of insurance concepts
  • Professional qualification in FLMI, ACII and IIK.
  • 5-8 years’ experience in case management two of which should be in a supervisory position

How to Apply

Apply for the job here

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