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Associate Jobs, Operations Associate, Corporate Jobs,
Corporate Care Management Associate
Job Purpose
Reporting to the Team Leader Corporate Care Management, The role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.
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Key responsibilities
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
- Interact with clients and service providers to ensure that the care is given within policy guidelines
- Review medical reports and claims for compliance with set guidelines
- Liaise with underwriters on scope of cover for the various schemes
- Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
- Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
- Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
- Delegated Authority: As per the approved Delegated Authority Matrix
- Prepare periodic reports for management on medical claims
- Ensure claims are processed within the stipulated time
- Perform any other duties as may be assigned from time to time
Key Performance Measures
- As described in your Personal Score Card
Knowledge, experience and qualifications required
- Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
- Moderate understanding of insurance concepts
- Professional qualification in FLMI, ACII and IIK.
- 5-8 years’ experience in case management two of which should be in a supervisory position
Corporate Health Document & Data Operations Associate (Medical Vetting)
Job Purpose
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Control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.
Key responsibilities
- Process all reimbursements as per SLA
- Process all claims from service providers as per SLA
- Process all reconciliation service provider invoices are reviewed and shared as per SLA
- Accurate and timely processing of client requests
- Manage escalation reports of recurrent issues vis-à-vis agreed Service Level Agreements.
- Escalate quality issues to Operations manager for management.
- Implement the customer experience strategy in the respective business divisions
- Investigate and respond to all internal and external customer enquiries promptly.
- Escalate complex queries to the appropriate functional area
- Maintain regular internal (to staff) and external (to customers) communication on Customer Service matters.
- Investigate and respond to all customer enquiries promptly.
- Carry out customer and product related document processing
- Respond to customer queries in a professional manner
- Make customers’ experiences better by ensuring customer satisfaction
- Ensure high standards of Customer Service are maintained in all at level
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
- Interact with clients and service providers to ensure that the care is given within policy guidelines
- Review medical reports and claims for compliance with set guidelines
- Liaise with underwriters on scope of cover for the various schemes
- Ensure that medical scheme members are attended to round the clock with support from a 24 hour call centre.
- Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
- Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
- Prepare periodic reports for management on medical claims
- Ensure claims are processed within the stipulated time
Knowledge, experience and qualifications required
- Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
- Moderate understanding of insurance concepts
- Professional qualification in FLMI, ACII and IIK added advantage
- 2-3 years’ experience in medical claims or case management position
Corporate CSE IFA/Branch
Job Purpose and Key responsibilities
Growth of IFA business to meet set annual premium targets.
Key responsibilities
- Secure new corporate business through intermediaries
- Retain existing corporate business as per set objectives
- Maintain excellent customer service to intermediaries and clients
- Service existing business and resolve customer complaints
- Follow up on renewals for corporate general insurance business
- Forward proposal forms to underwriting department
- Follow up premium collections for corporate clients
- Prepare weekly and daily reports as required
- Undertake initial underwriting in accordance with set guidelines to ensure sound acceptance of risk
- Respond to customer and client enquiries
- Follow up on commissions and claims issues emanating from intermediaries
- Recruitment of intermediaries as per set objectives
- Conversion of FA’s and IFA’S in the market to ensure all are placing corporate general insurance business
- Continuous execution of initiatives and strategies per market to ensure meeting of set objectives and reviewing them where need be.
- Training of intermediaries on general insurance products and submitting training schedules to supervisors.
- Use authorised incentive scheme to bring in new business through training intermediaries on the same and marketing it.
- Creating strategic partnerships with intermediaries for maximum business support.
- Sharing of market intelligence with supervisor
- Work closely with underwriter and branch manager and other lines of business to achieve set objectives
- Perform any other duties as may be assigned from time to time
- Delegated Authority: As per the approved delegated authority matrix
Key Performance Measures
- As described in your Personal Score Card
Knowledge, experience and qualifications required
- Bachelors’ degree in a business related field
- Professional qualification in Insurance (ACII, IIK)
- 2-4 year’s relevant experience in the insurance industry