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    Assistant Consultant, Care Management at - Nairobi, Kenya - Zamara Kenya

    Zamara Kenya
    Zamara Kenya Nairobi, Kenya

    6 days ago

    Default job background
    Full time
    Description
    Zamara is a financial services firm that primarily offers Actuarial Services, Pensions Administration and Consulting and Insurance Brokerage Services.

    Zamara has been in the Kenyan Market for over 23 years, initially operating as Hymans Robertson and more recently as Alexander Forbes.

    Summary


    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.

    This role reports to the Team Leader, Care Management.

    In more detail, the areas of responsibility include:
    Care Management

    Receiving calls on the 24-hour medical emergencies help lines
    Facilitate approval and authorization for Emergency Inpatient hospitalization e.g. post road traffic accidents from the insurance companies/underwriters.
    Outpatient treatment authorization (off smart/ no card)
    Facilitate evacuation processes to ensure favorable 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 favorable relationship is always maintained.

    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.

    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.

    Experience and personal qualities

    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
    Team player
    Problem Solving skills
    Self-Driven
    Flexible to train
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