Consultant Care Management (Mombasa)

The Zamara Group is a diversified financial services business specialising in pensions, medical services, insurance and actuarial solutions. Headquartered in Nairobi, Kenya, the Group has a presence in eight countries and a Pan-African ambition. Zamara has a rich heritage in Kenya spanning over 30 years.
ABOUT THE ROLE

1. Achieving Zamara’s ambitious strategic priorities will be complex and challenging. Its continued success will be dependent on building and retaining a world-class team. The Assistant Consultant will ascertain seamless service delivery to clients by offering support and assistance to medical insurance policy holders through the claims & call centre and at medical facilities, with minimal inconvenience, while supporting the overall goal of client satisfaction.

KEY ROLES AND RESPONSIBILITIES

1. Care Management

• Manning calls on the 24-hour medical emergencies help lines
• Facilitate approval and authorisation for Emergency Inpatient hospitalisation e.g. post road traffic accidents from the insurance companies/underwriters.
• Outpatient treatment authorisation (off smart/ no card)
• Facilitate evacuation processes to ensure favourable outcomes and reasonable charge to clients.
• Preauthorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
• Liaising with the Insurance companies in the process of undertaking and pre-authorizations.
• Provider panel management – ensuring required facilities are onboarded and favourable relationship is always maintained.
• Advocating for clients
• Negotiation of borderline claims
• Support with overseas referral
• Offer dedicated services to clients at their premises.

2.Reporting

• Provide data reports collected from various monitoring tools assigned to the role e.g. weekly and/or monthly reports.
• Trend analysis – hospital charges, cost of various packages etc

3.Value Adds

• Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge.
• Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers.
• Issuing Zamara gift packs - pack of diapers, branded get well / birth congratulations to admitted patients.

SKILLS AND QUALIFICATIONS

• A Diploma in Nursing Sciences/ Clinical medicine
• Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
• General understanding of the insurance industry is an added advantage.
• Capacity to build relationships
• Business etiquette
• Excellent interpersonal and customer service skills

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