Old Mutual Kenya is based in Nairobi and is part of a larger group that offers solutions in long-term savings, asset management and investment. We offer solutions to individuals and corporates underpinned by our core values which are: Respect, Integrity, Accountability and Pushing beyond boundaries.
RESPONSIBILITIES
- Pre-authorize scheduled and nonscheduled admissions within the set guidelines.
- Negotiate/discuss professional fees as appropriate for each admission.
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
- Visit all admitted clients within Nairobi region and its environs
- Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated.
- Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care.
- Revise reserves after discharge of member.
- Collect feedback from admitted clients on quality and scope of service by the service provider.
- Assist in carrying out verification and medical audit of claims/invoices before settlement.
- Develop and maintain monthly database on admissions, large claims and extended length of stay.
- Respond to queries from clients, intermediaries and service providers.
- Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.
- Any other duty assigned by management.
QUALIFICATIONS, KNOWLEDGE & EXPERIENCE
- Diploma or Degree in Nursing
- Diploma in Insurance/ COP
- Degree in Health systems Management/ Business management
- 3 years’ experience in clinical setting +2 years in insurance set up
- Provides a service as a temporary employee covering many fields
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