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Wednesday, January 25, 2017

Resolution Insurance CARE Manager Job in Mombasa, Kenya

Resolution Insurance Company Ltd is a general insurer offering innovative and responsive insurance solutions. We have learned to adapt in this constantly changing society, and develop comprehensive products that are relevant to our clients.
We currently have over 60,000 members in our fold and have partnered with over 500 medical service providers across East Africa; a strong network of hospitals, clinics and doctors.
The Resolution Insurance brand is energetic and trendy.
In pursuit of our ambitious growth plan, we are looking to fill the below position in our Medical Division, Mombasa Office.
CARE Manager – Mombasa
Reporting to the Head of Care and Medical Advisory, the Care Manager’s purpose is to monitor, evaluate and coordinate patient care within the medical benefit to ensure quality, appropriate and cost effective care, ensuring good business relationship with existing, new and potential Medical Service Providers.
Key Responsibility Areas:
CARE Manager Roles
1. Pre-authorization of scheduled and non-scheduled admissions to ensure validity, legitimacy of admission, and advice on cover scope.
2. Liaise with physicians to obtain RI client medical reports to ensure they are getting optimal, quality care as most appropriate.
3. Negotiate professional fees for each admission to ensure clients are receiving cost effective care within the scope of their cover.
4. Manage the 24-hour helpline and ensure client enquiries are sorted to satisfaction and assist with medical emergencies logistics.
5. Visit all admitted clients as part of company PR and to ensure the clients are getting appropriate satisfactory care.
Provider Relations Roles
6. Be the first contact to service providers on disputes from client’s complaints about Resolution Insurance audit.
7. Audit existing providers to ensure that protocol is adhered to [if not adhered to, make recommendation on next action-suspend/terminate/warning.]
8. Train providers on Resolution protocols to maintain standards
9. Maintain MSP contacts and undated contacts.
10. Maintain report on MSP visits and issues handled.
11. Maintain relationship with existing/new/potential MSPs
12. Renegotiation of terms with existing MSPs within set Resolution Insurance guidelines; make recommendations for changing terms outside the job’s guidelines.
Qualifications and Experience:
Essential:
  • Degree/Higher National Diploma in Nursing or Clinical Medicine.
  • KRCHN Registration
  • At least 1-3 years relevant working experience.
  • Good interpersonal, communication and negotiation skills.
  • Basic knowledge of computers and office operating programmes.
Desirable
  • Experience in an Insurance company.
  • A valid driving license.
  • A proven ability to build strong client relationships and maintain an excellent customer focus.
If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly Visit www.resolution.co.ke By COB, Tuesday, 31st January 2017.

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