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KEY TASKS & RESPONSIBILITIES
- Pre-authorize scheduled and emergency admissions within the defined guidelines.
- Determine the appropriate parameters for admission i.e. initial authorized cost and expected length of stay
- Negotiate professional fees as appropriate for each admission.
- Conduct hospital visits for admitted clients within the major towns
- Liaise with doctors on the day to day management of patients and obtain medical reports where indicated.
- Ensure smooth discharge process and coordinate any necessary post-hospitalization or stepdown care.
- Revise reserves after discharge of member.
- Collect feedback from admitted clients on quality and level of service by the providers
- Assist in verification and audit of inpatient claims prior to settlement
- Maintain relevant reports on admissions
- Promptly respond to queries from clients, intermediaries and providers
- Liaise with underwriting section for development of new products or benefits
- Proactively escalate any identified risks or risk events
- Any other duty assigned by management
SKILLS & COMPETENCIES
- Excellent communication and negotiation skills.
- Excellent interpersonal relationship skills.
- Extensive networking with SP and other medical insurers.
- Excellent analytical and monitoring skills
- Good decision making in benefit utilization management.
- High level of integrity and honesty
QUALIFICATIONS, KNOWLEDGE & EXPERIENCE
- Diploma/Bachelor in Nursing or Clinical Medicine
- Any insurance certification e.g. COP is an added advantage
- At least 2 years’ relevant experience within a health insurance
- At least 2 years’ experience in a busy hospital setting
Closing Date: 17 February 2021