Madison General Insurance – Supervisor – Care Management.

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Madison General Insurance Kenya Limited is a subsidiary of Madison Group Limited and is a well-known provider of General Insurance and Healthcare products in Kenya. The Group also provides through two other subsidiaries Life Assurance, as well as fund management services.

The Company is recruiting for the position of Supervisor – Care Management. The main responsibility of this role is Care Management, handling Outpatient, Optical, Dental and inpatient preauthorization, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns.

Key Responsibilities

  1. Care Management – Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise, for declines, ensuring that the decisions are accurate and a correct interpretation of the policy
  2. Ensure appropriate Turnaround Time is adhered to in issuing approvals.
  3. Seeking medical clarifications including medical reports, copies of investigation reports, etc
  4. Broker/customer relations by communicating all necessary admission claim decisions on a timely basis.
  5. Work with the claims team and coordinate on any information noted in the claims especially inpatient claims submitted in cases where further information provided changes the position undertaken previously on the claim.
  6. Review medical pre-authorization for compliance with applicable policy guidelines.
  7. Interacting with clients, brokers, and clinicians as needed, to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
  8. Visiting/engaging admitted patients and ensuring they receive quality and cost-effective care
  9. Engaging providers on matters of cost and discounts
  10.  

Job Specification

Qualifications

  • BSC Nursing
  • Basic understanding of the concepts of insurance
  • Proficient in the use of Microsoft office suite and packages

Experience

  • At least 2yrs working experience in an Insurance Company
  • 3 years’ experience in a Supervisory role

Qualified candidates are requested to forward their applications and detailed Cvs to the Human Resources Manager at: hr_recruitment@madison.co.ke on email not later than Friday 19th November 2021.

https://www.madison.co.ke/careers/supervisor-care-management/

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