Care Manager at Resolution Insurance Company Ltd

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  • Company: Resolution Insurance Company Ltd
  • Location: Kenya
  • State: Mombasa
  • Job type: Full-Time
  • Job category: IT/Telecom Jobs in Kenya

Resolution Insurance Company Ltd is a general insurer offering innovative and responsive insurance solutions.

We have learned to adapt in this constantly changing society, and develop comprehensive products that are relevant to our clients. We currently have over 60,000 members in our fold and have partnered with over 500 medical service providers across East Africa; a strong network of hospitals, clinics and doctors.

Reporting to the Manager – Medical Care Operations, the overall purpose of the Care Manager is to monitor, evaluate and coordinate medical benefits utilization to ensure quality, appropriate and cost effective care whilst ensuring good business relationships with existing, new and potential Medical Service Providers.

The jobholder is expected to demonstrate commitment and loyalty and perform all duties in accordance with the organization’s office routines and procedures, keeping in mind the overall business objectives.

Responsibilities

Care Management

  • Pre-authorization of scheduled and non-scheduled admissions to ensure validity, legitimacy of admission, and advice on cover scope.
  • Liaise with physicians to obtain RI client medical reports to ensure they are getting optimal, quality care.
  • Negotiate professional fees for each admission to ensure clients receive cost effective care within the scope of their cover.
  • Manage the 24-hour helpline and ensure client enquiries are sorted to satisfaction and assist with medical emergencies logistics.
  • Visit all admitted clients to ensure they get satisfactory care.

Provider Relations

  • Be the first contact for medical service providers regarding client complaints/feedback.
  • Audit existing providers to ensure that due procedure is adhered to and where not adhered to, make recommendations on next course of action – suspend/terminate/warning.
  • Train providers on Resolution procedures to maintain quality standards.
  • Maintain updated contacts of medical service providers.
  • Build and maintain strong business relationships with existing/new/potential MSPs.
  • Renegotiation of terms with existing MSPs within set Resolution Insurance guidelines; make recommendations for changing terms outside of the existing guidelines.

Qualifications

Essential

  • Degree/Higher National Diploma in Nursing or Clinical Medicine.
  • KRCHN Registration.
  • At least 1-3 years’ relevant work experience.
  • Good interpersonal, communication and negotiation skills.
  • Basic knowledge of computers and office operating programmes.

Desirable

  • Previous experience in an Insurance company.
  • A valid driving license.
  • Proven ability to build strong client relationships and maintain excellent customer focus.

How to Apply

If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly visit our careers page on http://www.resolution.co.ke/careers by Close of Business on, 31st March 2019.

Applications should be made strictly through the careers portal.

Only shortlisted candidates will be contacted.

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