Summary
Date Posted: Thursday, October 22, 2020 , Base Salary: Not Disclosed

JOB DETAILS:
Job Title: Manager, Care Management,
Location: Nairobi,
Job Description
We are a leading Insurance Company, affiliated to Liberty Group, a wealth management company represented in 18 African countries. We use our knowledge and action to guide our customers on their journey to financial freedom. We believe in responding to the changing consumer and market needs through innovative solutions and technologically efficient processes.
The jobholder will be responsible for ensuring that Heritage customers receive aGordable, accessible, cost eGective and high quality healthcare services. .

Responsibilities
• Develop and maintain care management processes
• Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariGs
• Coordination of the contact centre, ensuring that clients have access to the 24 hour hotlines; as well as monitoring weekly performance
• Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers
• Visit all admitted clients and ensure that the clients are getting appropriate satisfactory care
• Liaison and coordination with providers and finance team to help in the reconciliation and closureof accounting periods as shall be specified in a timely manner
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration) and ensure their compliance
• Interact with clients and service providers to ensure that the care given is within policy guidelines and there is client satisfaction
• Review medical reports and claims to ascertain their compliance with Heritage’s health business set guidelines, policies and procedures
• Liaise with underwriters on the scope of cover for the various schemes
• Evaluate, Accredit and appoint providers and negotiate contracts, discounts and packages
• Coordination of local and international emergency evacuations, referrals and transfers
• Ensure inculcation of the TCF (Treating Customers Fairly) culture
• Implement a preventive care programme through health talks, the wellness programme and the Chronic Disease Management programme
• Continuous member education on policy benefits to ensure adherence to scheme rules
• Review of medical services for appropriateness and cost-eGectiveness based on established medical standards
• Clinical assessment of the treatment protocols
• Ensure all contracted providers have service level agreements
• Communicate with the policyholder liaison oficers
• Ensure a nationwide health care provider network
• Train and audit providers during periodic service meetings
• Provide support to the business development team in the growth and maintenance of the medical book
• Ensure savings through NHIF enhanced benefits
• Coordinate approvals of all guaranteed and roaming cases
• Timely resolution of complaints
• Notify stakeholder teams of declined cases as per the policy guidelines
• Coordinate preparation and circulation of periodic heath nuggets

Job Skills: Not Specified

Qualifications
• Degree or Diploma in Medicine, Nursing, Clinical Oficer or Pharmacy
• Professional qualification in Insurance (AIIK or ACII) will be an added advantage
• 10 years’ experience in health insurance, 3 of which should be in a supervisory role
• Understanding of health insurance operations and concepts
• Customer, market and competitor understanding
• Knowledge of insurance regulatory requirements
• Knowledge of health insurance products
• High level of numeracy and strong analytical skills
• Strong negotiation and business management skills
• Experienced leader with interpersonal sensitivity
• Quality decision making and listening skills
• Conflict handling skills

Job Education Requirements: Not Specified

Job Education Experience: Not Specified

Work Hours: 8

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Job application procedure
If you meet the above requirements, you are encouraged to forward your application and updated CV to vacancies@heritage.co.ke by 27th October 2020. Clearly state the job title on the subject heading.
Heritage is an equal opportunity employer and actively encourages diversity. Please note that only shortlisted candidates will be contacted.

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