EMC Medical Claims Associate at Britam

EMC Medical Claims Associate at Britam… See details on how to apply for the opportunities available at Britam.

Descriptions;

Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. The group offers a wide range of financial products and services in Insurance, Asset management, Banking and Property. Our Mission is to provide outstanding financial services to our customers. Our Vision is to be the most trusted financial service partner. We aim to provide our clients, with an unmatched offering, ensuring first class solutions that help secure the future.

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
  • Perform any other duties as may be assigned from time to time.

Requirements:

Knowledge, experience and qualifications required

  • Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
  • Moderate understanding of insurance concepts
  • Professional qualification in FLMI, ACII and IIK.
  • 5-8 years’ experience in case management two of which should be in a supervisory position

How to Apply

Application Deadline: 31st August 2022.

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