Case Management Officer

Updated: May 09, 2024 05:12 AM GMT

Britam

Nairobi

Job Purpose

Controlling and Managing policies through case management to ensure quality and cost effective care, client service, provider management, processing and payment of claims.

Key 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.
• Discourage poly-pharmacy by diligently challenging of prescriptions and suggesting better alternatives as per medical practice.
• Encourage use of generics and cost effective quality drugs where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Review documents and pertinent requirements... More Detail