Care Officer – Medical at CIC Insurance

PURPOSE:

• Responsible for accurate capture of inpatient undertakings, authorization, cost control and hospital length of stay management.

PRIMARY RESPONSIBILITIES:

• Facilitating admissions and discharges of insured members as per policy.
• Conduct hospital visits
• Manage cost and average length of stay while the patients are in hospital to ensure prudent utilization.
• Pre-authorize treatment for outpatient/inpatient cases as per the policy guidelines
• Timely respond to all queries from insured client, service providers and respective contact person on cases involving medical care management.
• Maintain a good relationship with partners such as intermediaries at care management level.
• Update the relevant stakeholders on the case management update
• Coordination and facilitation of both road and air evacuation as per policy.
• Seamless Coordinating of overseas treatment from admission to discharge.
• Compile relevant reports within the scope of care management as per stipulated guidelines
• Receive and respond to Medical emergency lines on a 24-hour basis to ensure adequate coverage of the call Centre
• Negotiate for discounts from doctors and service providers on specific cases and procedures as they arise.

Academic and Professional Requirements

Education   

• Bachelor’s degree in Nursing or clinical Medicine.    E
• Computer literate in MS Office and other office applications    E
•  Medical Insurance experience in a medical call centre is an added advantage    D

 Experience Required:

• Relevant experience in busy health environment    3