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Case Management Officer
Job Purpose:
Reporting to the Assistant Manager Case & Provider 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.
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.
- Prepare periodic reports for management on medical claims.
- Ensure claims are processed within the stipulated 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
- Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
- Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
- 3-6 years’ experience in case management.
- Proven experience in managing and nurturing client relationships.
- Track record of achieving client satisfaction and retention targets.
Technical/ Functional competencies:
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.
- Sales and marketing management skills.
Assistant Claims Officer
Job Purpose:
To effectively process medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement. This includes verifying submitted claims, assessing reimbursement policies, performing reconciliation with claims estimates, and conducting payment negotiations and providing support on the process of medical claims as well as support of all retention strategies.
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.
- Poly-Pharmacy – discourage polypharmacy 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.
- Analyze proposed risks and make decisions to accept or reject.
- Determine the rates and terms to charge.
- Ensure risk survey recommendations are communicated in time and follow up implementation.
- Ensure underwriters comply to the company credit policy.
- Build and manage relationships with brokers, agents, and other intermediaries.
- Monitor market trends and competitor activities to stay informed about industry developments and stay updated on changes in laws and regulations that may affect client retention efforts.
- Work closely with sales, marketing, actuarial, to align retention strategies with business goals.
- Proactively manage the policy renewal process to ensure timely renewals and minimize lapses in coverage.
- Review and negotiate renewal terms and conditions with clients to retain their business.
- Develop and implement strategies to improve client retention rates.
- Prepare periodic reports for management on medical claims.
- Ensure claims are processed within the stipulated time.
- Delegated Authority: As per the approved Delegated Authority Matrix.
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Key Performance Measures:
As described in your Personal Score Card.
Knowledge, experience and qualifications required
- Diploma/Degree in Nursing/ Diploma in clinical medicine/ Diploma in Pharmacy/ Bachelor’s degree (insurance option preferred).
- Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
- 1-3 years’ experience in Health.
- Proven experience in managing and nurturing client relationships.
- Track record of achieving client satisfaction and retention targets.
Technical/ Functional competencies:
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.
- Sales and marketing management skills.
Business Strategy Support Analyst
Job Purpose:
- The role holder will be responsible for providing relevant insights that help the organization make better decisions, identify possible new growth initiatives, and build a pipeline of opportunities for partnerships.
- They will gather, review, and test data and apply measures to provide solutions to critical business issues and decisions.
- He/she will ensure that the business has strategically aligned its resources and costs to the efficiently deliver strategy by investing in areas that really matter and running lean on areas that matter less and that the business has an aligned, supportive and focused decision making and organization culture.
Key responsibilities:
- Establish priorities in line with the company overall strategy. Work with Business heads to establish and continuously review the group’s key strategic priorities and translate them into strategic initiatives;
- Ensure all strategic initiatives meet shareholder ROI requirements and are in line with the Group’s risk appetite.
- Support the strategic planning process by working with the respective businesses in defining performance metrics and targets, designing new processes and establishing performance dialogues that cascade through the organization based on data, developing dashboards that are data driven and ensuring alignment across all BUs.
- Implement data analytics projects to help manage the organization through data and to drive performance based on data and insights arising from deep analytics.
- Work with BU heads to translate strategy into actionable and quantitative plans; Lead the development and innovation of new strategic initiatives and assist management in decision making.
- Provide actionable insights to improve strategy and performance through financial analysis and modelling.
- Develop dashboards, executive summaries, and weekly/monthly reports to measure against KPIs and market dynamics.
- Identify potential business issues and develop contingency plans to effectively mitigate risks.
- Contribute to key accounts by project managing work streams and/or leading delivery teams.
- Present findings from analysis to external and internal clients/stakeholders.
- Undertake market analysis/modelling, portfolio metric reporting, and operational support related to the firm/team’s strategy.
- Ensure all strategic initiatives are incorporated into yearly budgeting cycle.
- Where necessary, partner with business leaders, special committees, and consultants to support execution of key strategic initiatives.
- Deliver on performance requirements as defined in the Strategy and EPMO department’ strategy map, balanced scorecard and Personal Scorecard.
- Maintain a healthy and updated enterprise wide projects portfolio dashboard with the ability to quickly generate management reports on the portfolio status at any point in time. It is expected that the portfolio will consistently have projects at various staged of the project management lifecycle all the way from ideation to benefits realization.
- Provide key inputs for the annual financial integrated report and support its development from conception to completion.
- Engage with investors or plan investor meetings to discuss the strategy and progress.
- Able to create high level PowerPoint presentations on strategy and performance and present to relevant audience.
- Delegated Authority: As per the approved Delegated Authority Matrix.
Key Performance Measures:
As described in your Personal Score Card.
Knowledge, experience and qualifications required
- Bachelor’s or Graduate’s Degree in business, business administration, computer science, economics, statistics or equivalent experience.
- Experience with frameworks, statistics, and algorithm design with strong quantitative and financial modelling skills and Proficiency in Microsoft Office tools (Excel, PowerPoint, Access, etc.)
- Certification in the Balanced Scorecard or Project Management etc. would be an added advantage.
- 3 – 5 years relevant experience in strategy development and implementation, business planning and analysis or in strategy consulting.
- Comfortable utilizing business case development and strategic thinking to solve problems.
- Excellent verbal and written communication skills to clearly articulate the insights from findings to management and relevant stakeholders.
- A good financial/ commercial and business acumen with proper understanding of financial statements.
- Comfortable negotiating and collaborating with others and must be able to work with cross-functional teams.
Technical/ Functional competencies:
- Strong in Strategic analysis and understanding of various methods; PESTEL/STEEP analysis, SWOT analysis, Porter’s Five Forces Framework, Ansoff Matrix, Value Chain Analysis.
- Excellent financial modelling and analysis skills including.
- Excellent networking, interpersonal and presentation skills.
- Flexibility and adaptability.
- Excellent in written and oral communication skills.
- Project management skills – preferably a formal project management qualification (e.g. Prince2).
- Excellent PowerPoint and Excel skills.
- Knowledge in Diversity management.
- Ability to drive change.
- Stakeholder Management.
- Report writing-ability and ability to develop business cases.
- Strategic Planning.
- Decision making –ability to make strategic decisions in a timely and effective manner.
- High moral and ethical standing.
- Highly motivated.
Insurance Unit Sales Manager
About the job
- Must have a Certificate of Proficiency in Insurance (COP) licence.
- Must have a minimum of a diploma certificate in any field. A degree certificate is an added advantage.
- Minimum of 2 years of experience in management of Financial Advisors.
- Miminum of two years of experience in selling of insurance products.
- Excellent communication and problem solving skills.
- Be ready to work in Kitengela town.