Job Description
Job Purpose
Controlling and Managing policies through case management to ensure quality and cost effective care, client service, processing and payment of Britam Microinsurance 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.
Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
Review documents and pertinent requirements regar...
Controlling and Managing policies through case management to ensure quality and cost effective care, client service, processing and payment of Britam Microinsurance 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.
Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
Review documents and pertinent requirements regar...
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