CIC Insurance Group Limited is a leading insurance and investment group operating in Kenya, Uganda, South Sudan, and Malawi. The Care Officer is responsible for care facilitation, cost containment, and ensuring call centre reachability. This role involves managing the medical care process for insured members, ensuring compliance with policy guidelines while optimizing costs.
Key Responsibilities
Authorizations: Issue approvals for both inpatient and outpatient care according to policy guidelines.
Cost Control: Monitor medical costs and the average length of stay for inpatient cases.
Specialized Guidance: Provide pre-authorization guidance for optical, dental, and scheduled medical procedures.
Patient Advocacy: Conduct hospital visits for hospitalized insured members.
Communication: Respond to stakeholder inquiries regarding medical care management.
Emergency Support: Manage medical emergency lines, ensuring 24-hour coverage.
Provider Negotiation: Negotiate discounts with doctors and hospitals for specific cases and procedures.
Logistics: Facilitate medical referrals and evacuations when necessary.
Utilization Monitoring: Track benefit usage and provide updates to stakeholders.
Reporting: Prepare and submit timely reports as required.
Requirements
Education: Diploma in Nursing or Clinical Medicine.
Experience: Minimum of 2 years of experience in care management, medical claims, and Call Centre operations.
