The Care Assessor at APA Life Assurance Company Ltd is responsible for managing the continuum of care for insured clients. This includes reviewing pre-authorizations, handling client inquiries via the 24-hour call center, and conducting hospital visits to monitor patient management and maintain provider relationships.
Key Responsibilities
Pre-authorization Management: Reviewing and issuing pre-authorization for medical procedures in accordance with policy guidelines.
Call Center Operations: Handling the 24-hour call center (mobile and office lines) and providing timely responses to client queries.
Stakeholder Coordination: Interacting with clients, brokers, clinicians, relationship officers, and HR representatives to resolve issues and update progress.
Hospital Assessments: Conducting hospital visits to assess patient care throughout the continuum of care for various diagnoses and procedures.
Relationship Management: Maintaining professional relationships with both clients and service providers during hospital interactions.
Compliance & Reporting: Reporting adverse occurrences in patient management and taking appropriate actions to ensure compliance with quality care standards.
Chronic Disease Management: Coordinating step-down management and referrals for clients with chronic conditions.
Corporate Engagement: Participating in health talks, wellness camps, service meetings, and brand-building activities including CSR initiatives.
Requirements
Academic Background: Bachelor’s degree in a relevant field.
Professional Qualifications: Possession of a relevant professional certificate.
Experience: Minimum of 4 years of relevant experience in a similar role within the insurance or healthcare sector.
Competencies: Strong leadership, interpersonal, communication, and analytical skills.
