Job Summary
To perform all the case management roles both at the contact centre and back office, which includes but not limited to:
Job Description
Sensitise and Provide information to clients about their policy guidelines.
Continuously advise clients about the most cost-effective service options to Clients/Brokers/Agents/ company Human resource managers.
Facilitate for member sensitization and registration.
Organize for hospital transfers and evacuations in reference to their policies.
Calls managements in line with the international call centre standards.
Organise and participate in Carrying out health forums for clients.
Professional Handling of clients and service providers grievances within the stipulated time.
Managing requests for services from providers, intermediaries, and clients, providing information on the FAK provider network, available benefits per scheme policy and services and other routine information
Respond to all emails and give feedback within one 30 minutes of receiving them.
Critically analyse and give accurate response to all pre-authorization within the defined TATs and in line with member policy benefits.
The care manager to accurately to decode prescriptions and other bills to identify any anomalies.
Negotiate with service providers for sustainable costs containment.
Mitigate fraud cases through hospitals visitation of admitted patients in various hospitals, and vet all inpatient bills.
Ensure the service access turnaround time is within the stipulated Service Level agreement, Discharges within 30 minutes, outpatient responses within 10 minutes.
Sending daily admissions reports to clients; Brokers/Agents/ company Human resource managers.
Offer first aid to any emergency cases within/around First Assurance Office.
Response to all escalations from the contact centre, carrying out customer surveys, social media and email management.
Performs all other tasks as assigned by the Line manager.
Education Qualifications & Experience
Bachelor's degree or Diploma in nursing or clinical Medicine and Surgery
Minimum of 1 - 3 years' experience in a similar role in the insurance industry.