About the Role

Responsible for care facilitation/cost containment and call centre reachability.

Key Responsibilities

• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
• Monitor cost, average length of stay on inpatient cases.
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
• Conduct Hospital visits whenever the insured members are hospitalized
• Respond to stakeholder inquiries on cases involving medical care management.
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
• Facilitate referrals and medical evacuations when need be.
• Monitor benefits utilization and share timely updates to the stakeholders.
• Prepare and share timely reports as may be guided.

Who We’re Looking For

Essential Knowledge/Skills and Experience Required:

• Diploma in Nursing or Clinical Medicine
• Minimum of 2 years of experience in care management, medical claims and Call Centre

• Issuance of approval to insured members seeking both inpatient and outpatient care as per policy guidelines.
• Monitor cost, average length of stay on inpatient cases.
• Issue guidance on Pre-authorized optical, dental and scheduled procedures
• Conduct Hospital visits whenever the insured members are hospitalized
• Respond to stakeholder inquiries on cases involving medical care management.
• Receive and respond to Medical emergency lines and ensure 24-hour coverage
• Negotiate for discounts from doctors and hospitals on specific cases and procedures from time to time
• Facilitate referrals and medical evacuations when need be.
• Monitor benefits utilization and share timely updates to the stakeholders.
• Prepare and share timely reports as may be guided.

• Care management
• Medical claims
• Call Centre

• Diploma in Nursing or Clinical Medicine