Customer Care , Medical and Healthcare Jobs, New Job Openings,
Call Centre Nursing Executive – Medical Contact Centre
PURPOSE:
To provide general customer service in respect to medical business customers.
PRIMARY RESPONSIBILITIES:
- Receive and respond to Medical emergency lines and ensure 24 hour coverage.
- Resolve customers’ communication through electronic and physical channels (Emails and walk in clients).
- Issuance of both in and outpatient approvals for admissible requests for insured members.
- Communication to stakeholders on management of cases and financial liability through reports.
- Provide input for the customer service reports.
- Handle customer service issues and queries.
- Escalate Customer queries to the relevant job role if necessary.
- Promote the organization’s customer service charter.
Academic and Professional Requirements
Education
- Minimum of a Diploma in Nursing (KRCHN)
- Computer literate in MS Office and other office applications
- Customer Experience training will be an added advantage
Experience Required:
- Relevant experience in busy health environment 3
- Experience in a medical call centre management unit 1
Claims Analyst/Vetting Officer – Medical
PURPOSE:
Responsible for vetting both in/ outpatient medical claims for payment.
PRIMARY RESPONSIBILITIES:
- Vet and audit inpatient and outpatient medical bills/invoices in order to pay service providers promptly.
- Process reimbursement claims within the stipulated TAT.
- Batch outpatient invoices on the system and adjust amount payable as per the vetting findings;
- Check and reject incomplete invoices and return with supporting documents to service providers;
- Negotiate, adjust and update service providers on their cost and accounts status;
- Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills;
- Review claims reserves on a continuous basis in view of new developments;
- Attend to stakeholder queries and complaints promptly and professionally
- Recommend risk improvement measures to the underwriter to take appropriate action.
- Fraud detention within claims function and escalation of any suspicious claims to the supervisor
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Academic and Professional Requirements
Education
- Minimum of a Diploma in Nursing (KRCHN)
- Computer literate in MS Office and other office applications
Experience Required:
- Relevant experience 3
Claims Receiving Officer – Medical
PURPOSE:
Responsible for receiving and processing claims for provider payment.
PRIMARY RESPONSIBILITIES:
- Ensure that all claims received are well stamped and keyed in for future reference.
- Dispatch received invoices, mails and claim books to respective sections
- Dispatch claim forms and other relevant documents to providers
- Confirm that smart claims have been billed correctly
- Prepare valid claims for scanning.
- Upload, attach and index relevant documents to Document Management System
- Facilitate discarding of scanned claim documents as per the approved disposal procedure.
- Registration of medical claims in the system
- Follow up on registration and reconciliation of provider statements to ensure closure.
- Follow through to ensure all claims with issues at registration level have been addressed or escalated to the supervisor for action
- Respond to walk in customer enquiries
- Attend to customer and service providers’ queries and complaints promptly and professionally
Academic and Professional Requirements
Education
- Bachelor’s Degree/Diploma
- Bachelor’s degree in a business related field or a Diploma in Health Records
- Computer literate in MS Office and other office applications
Experience Required:
- Relevant experience 1