The Position: Reporting to the Healthcare Administrator – Bancassurance, the role holder will be responsible for day to day engagement with medical providers to ensure quality healthcare provision to members of medical schemes as well as analysis of medical bills submitted for settlement.
Key Responsibilities
Manage a 24 hour on-call services in management of medical scheme issues.
Respond to queries, telephone calls, and letters from the various stakeholders regarding the Banks’s medical scheme.
Review all medical/surgical billings for reasonable and necessary charges.Vet and analyse medical claims as per scope of cover whilst ensuring strict adherence to set guidelines and TAT.
Prepare members’ reimbursement claims and payment of the credit to the medical providers.
Prepare utilization reports as required by member / client.
Ensure reconciliation of medical providers’ bills & accounts on an ongoing basis or on demand including visits to providers; recommend appropriate payment of dispute of billing, as necessary.
Evaluate claims referred for medical management and make recommendations for follow-up, further investigation or documentation as necessary.
Provide professional assistance to all the staff members/dependents with chronic ailments and facilitating follow up in specialists’ clinics.
Arrange emergency evacuations for medical scheme members’ country wide.
Update staff medical statements and ensuring all utilizations are captured on a timely basis.
Provide staff training and member education on quality health care cost containment and utilization.
Establish channels of communication with providers to familiarize them with Bank’s guidelines.
Attends mediations and other hearings to inform and defend the cost containment procedures, guidelines and decisions rendered.
Maintain records, prepare reports and other correspondence related to the Medical Claims.
Qualifications and Requirements
A Diploma in Kenya Registered Community Health Nursing/ Clinical Medicine/ Pharmacy and/ or any other medical related course i.e. Medical Laboratory.
At least 3 years’ experience in a busy Health Insurance environment with Claims Vetting & Care management.
Training in Basic and Advance Life Support.
Computer literate and familiar with standard office software applications.
Team player with strong communication, interpersonal and persuasive skills.
Good planning and organization skills with the ability to deliver effectively under strict deadlines.
Attention to detail.
Great ability to build and maintain strong working relationships with a wide range of internal and external stakeholders.
Ability to maintain strict confidentiality and integrity of all information in their possession.
The above positions are demanding roles which the Bank will provide a competitive package for the successful candidates.
If you believe you can clearly demonstrate your abilities to meet the criteria given above, please submit your application with a detailed CV, stating your current position, remuneration level, e-mail address and telephone contacts quoting the job title/reference in the subject field to recruitment@kcb.co.ke.
To be considered your application must be received by Aug. 7, 2015.
Only short listed candidates will be contacted.