The Assistant Claims Officer is responsible for controlling and managing the policy cycle through pre-authorization and case management. The primary objective is to ensure that clients receive high-quality, cost-effective care while maintaining compliance with internal policy guidelines and insurance standards.
Key Responsibilities
Claims Processing: Ensure all received claims (both credit and reimbursement) are vetted and released to finance within stipulated timelines.
Case Management: Set appropriate parameters for each medical admission and claim for both In-Patient (IP) and Out-Patient (OP) services, including claim reserves, initial authorized costs, and duration.
Stakeholder Interaction: Interact with clients and service providers to ensure care is delivered within policy guidelines.
Compliance: Review medical reports and claims for compliance with established organizational guidelines.
Underwriting Collaboration: Liaise with underwriters regarding the scope of cover for various insurance schemes.
Cost Management: Discourage poly-pharmacy by challenging prescriptions and suggesting alternatives. Encourage the use of generic medications to reduce pharmaceutical expenditure.
Reporting: Prepare periodic reports for management on medical claims and processing efficiency.
Authority: Operate within the approved Delegated Authority Matrix.
Requirements, Experience, and Qualifications
Academic Background: Diploma or Degree in Nursing, Clinical Medicine, or Pharmacy.
Experience: 5-8 years of experience in case management, with at least 2 years in a supervisory position.
Professional Certifications: Professional qualifications such as FLMI, ACII, or IIK are required.
Technical Knowledge: A moderate understanding of insurance concepts and medical insurance processes.
How to Apply
Interested and qualified candidates should apply via the Britam career portal at https://www.myjobmag.co.ke/apply-now/1147047. The application process is handled through the Britam Taleo system.
How to Apply
Interested and qualified candidates are invited to apply online through the Britam recruitment portal at https://www.myjobmag.co.ke/apply-now/1147047. Ensure you fulfill all educational and professional certification requirements before applying.
