Corporate Care Management Associate
Job FieldInsurance , Medical / Healthcare
Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost-effective care.
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 the scope of cover for the various schemes
Ensure that medical scheme members are attended to round the clock with support from the 24-hour call center.
Poly-Pharmacy – discourages poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
Generic substitution – Encourage the use of generics was indicated as a method of reducing the organization’s pharmaceutical expenditure.
Delegated Authority: As per the approved Delegated Authority Matrix
Prepare periodic reports for management on medical claims
Ensure claims are processed within the stipulated time
Perform any other duties as may be assigned from time to time
Key Performance Measures
As described in your Personal Score Card
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
Leadership category responsibility framework (Core Competencies
Emerging Leaders In Britam Need To
Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost, and team targets;
Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation;
Ensure that department priorities are adhered to and effectively communicated;
Ensure competent and effective people resources through appropriate coaching, development, and people supervision as appropriate;
Embody a high-performance, proactive culture;
Effectively ensure the adherence to key performance areas, deadlines, and goals in order to optimize operational effectiveness;
Effectively communicate resource needs, possible opportunities, and achievements to management in order to aid them in their decision-making;
Effectively set and monitor priorities and objectives for more junior staff;
Understand and communicate objectives in relation to the larger organizational impact;
Effectively disseminate knowledge within the correct context, towards subordinates as well as management;
Appropriately model the company values while setting the pace and energy for delivering;
Effectively manage and communicate change within the department in order to increase staff and process effectiveness;
Provide access to accurate and consistent information and services across all channels;
Ensure a seamless experience for clients;
Improve service delivery for clients;
Engage in continuous brand building to become the trusted partners of clients
Emerging Leaders Competency Descriptions.
Presenting and Communicating Information – Speaks fluently; expresses opinions, information, and key points of an argument clearly; presents effectively; responds quickly to others ‘reactions and feedback during conversations; projects credibility.
Working with People – Shows respect for the views and contributions of team members; shows empathy; listens, supports, and cares for others; consults others and pro-actively shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the team and fits in well.
Adhering to Principles and Values – Upholds and encourages ethical behavior and departmental values; demonstrates integrity; encourages individual responsibility towards the community and the environment; models the organizational values during everyday interactions.
Analyzing – Analyses numerical data and all other sources of information, breaking them into component parts, patterns and relationships; probes for further information or greater understanding of a problem; make rational judgments from the available information and analysis; demonstrates an understanding of how one issue may be part of a much larger system/process/problem.
Planning and Organizing – Adheres to and monitors clearly defined objectives; plans activities and projects well in advance and takes account of possible changing circumstances; identifies and organizes resources needed to accomplish tasks; manages time effectively; monitors performance against deadlines and milestones.
Delivering Results and Meeting Customer Expectations – Focuses on customer needs and satisfaction; sets and models high standards for quality and quantity; monitors and maintains quality and productivity; works in a systematic methodical and orderly way; consistently achieves projects goals.
Deciding and Initiating Action – Takes responsibility for own, as well as subordinates’ actions and projects; takes initiative and works under own direction; initiates and generates activity; introduces improvements into work processes; handles problems with minimal guidance.
Leading and Supervising – Provides subordinates with a clear direction; motivates and empowers others; provides subordinates with the relevant coaching; creates a positive climate that fosters learning and development; identifies high potential talent; sets and articulates the departmental vision and values through own personal behavior; set appropriate standards of behavior.
Formulating Strategies and Concepts – Works strategically to realize personal goals; understands and effectively communicates the departmental strategy; translates the departmental strategy and vision into operational responsibilities; takes into consideration departmental strategy during all tasks; takes account of a wide range of issues across, and related to the current role.
responsibilities; takes into consideration departmental strategy during all tasks; takes account of a wide range of issues across, and related to the current role.
Applying Expertise and Technology – Applies specialist and detailed technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organizational departments and functions.
Following Instructions and Procedures – Challenges authority only when appropriate; follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates a commitment to the organization; complies with legal obligations and safety requirements of the role.
Adapting and responding to change – Adapts to changing circumstances; tolerates ambiguity; accepts new ideas and change initiatives; adapts interpersonal style to suit different people or situations; shows an interest in new experiences.
Technical/ Functional competencies
Knowledge of insurance regulatory requirements
Knowledge of insurance product
Sales and marketing management skills
MODE OF APPLICATION
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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.