GA Insurance Nursing Officer (Health Division) Jobs career in Kenya 2013

Title: Nursing Officer (Health Division)
Reports to: Head of Health Division
 
Job Summary: The jobholder will be responsible for Claims Processing, Hospitals undertakings and Visits, Customer Care, credit vetting and control and bills reconciliation and approval as per the company policy guidelines.
Responsibilities
  • Keying of claims – both reimbursement and credit.
  • Vetting of claims, checking on what is payable and not payable, either due to the nature of illness or mode of treatment or payment within the Kenya Medical Practitioners & Dentist Board guidelines.
  • Assisting colleagues on interpreting and processing of claims i.e. ensuring diagnosis is within medical insurance cover and diagnosis matches treatment offered.
  • Liaise with doctors, brokers and clients at large for patient admissions.
  • Advise members on how best to utilize their benefits by recommending cheaper facilities and cheaper options e.g. maternity packages, chronic management facilities.
  • Advising doctors on referral of patients with chronic illness to cheaper facilities.
  • Capping/reviewing of undertaking through advise through letters to providers where and when necessary to avoid exceeded limits and hospitals/doctors taking advantages.
  • Sending undertakings to providers within the timelines.
  • Go through pre-authorization forms and scrutinize forms especially for clear diagnosis management and nature of treatment.  Requesting for further information/medical reports where treatment needs.
  • Nurturing a good relationship with doctors, hospitals, brokers and other service providers.
  • Patient visits for psychological support and ensuring they are receiving proper medical treatment.
  • Updating providers with current list of members covered, those who have exceeded limits and not to access services.
  • Arrange for health talks / cover review and ways of reducing over usage for clients.
  • Come up with a sufficient and efficient credit panel for our entire clientele.
  • Ensure all credit providers are kept in check and ensuring smooth relationship between our credit panel and ourselves.
  • Provider reconciliation and liaise with brokers on where member accessed service not authorized which needs to be paid to providers.
  • Sending invoices of exceeded limits to Brokers / Companies for payment.
If you meet the above minimum requirements, send your c.v to henry@gakenya.com indicate the position applied for on the email subject line so as to be received not later than 13th March, 2013.
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