Purpose for the Job

• The main purpose for the job is to ensure that Minet clients receive quality healthcare at the most reasonable cost, enhance customer experience and offer clinical support to the business.

Duties and Responsiblities

Case management & Pre-authorization 

• Timely adjudication and issuance of approval letters as per policy guidelines.
• Ensure that all admitted patients are visited and case management process is compliant to ISD protocol.
• Management of Special Cases & Arbitration.
• Management of ACOS & ALOS.
• Manage local and abroad evacuations.
• Cost containment
• Enforcement of rates, Discount negotiations, Client Advisory, Step down management, Discharge planning, Homecare management.
• Call Centre Management
• Effective management of the 24-hour call Centre. Ensure seamless access to care.
• Professional, accurate and timely responses to clients.
• Attend to customer feedback/complaints.
• Timely escalation and reporting of any incidences.
• Maintain desired call drop rate.
• Enhance Customer Experience
• Establish and maintain good relationships with internal and external stakeholders such as Health care service providers, Insurers, Contracted providers etc.
• Referral to CDM Programs
• Process Management
• Preparation of relevant reports
• Any other duty as may be assigned by the supervisor.

Key Result Areas

• The accountability areas are as follows:
• Case Management visits to all Funded and insured clients.
• Call Centre support – Customer service.
• Cost Management / Cost containment
• Customer satisfaction.
• Team Cohesion.

Key Competencies

• The accountability areas are as follows:
• Knowledge of Insurance practice.
• Outstanding Decision-making skills.
• Interpersonal skills.
• Strong Negotiation skills.
• Report writing skills.
• Knowledge And Skills Required
• Clinical /Medical background & knowledge.
• Data Analytics & Computer Literacy.
• Time Management .
• Excellent verbal and written communication skills.
• Solution Oriented.

Professional and Academic Qualifications

• The jobholder must possess:
• Diploma in Nursing or Clinical medicine, B.Sc. Health Systems Management will be an added advantage.
• 2 years’ experience in Health Insurance Operations.