Jobs at CIC Insurance

PURPOSE:

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

PRIMARY RESPONSIBILITIES:

• Monitor inpatient authorizations and admission undertakings;
• Monitor cost control, average length of stay on inpatient authorizations;
• Pre-authorize optical and scheduled cases;
• Coordinate medical care monthly Rota and duty allocation and ensure conformity to rota and assigned duties/coverage;
• Respond to client, provider and contact person queries on cases involving medical care management;
• Receive and respond to Medical emergency lines and ensure 24-hour coverage and
• Negotiate for discounts from doctors on specific cases and procedures as they arise.

 GENERIC DUTIES

• Carry out performance appraisal, coaching and mentoring staff;
• Participate in planning and budgeting for the department.

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s degree in Health System Management, Nursing or in a related field

Professional Qualifications

• COP-Insurance is an added advantage

Experience

• Up to three (3) years’ relevant experience

Skills and Attributes

• Problem solving skills;
• Good analytical skills;
• Computer literate in MS Office and other office applications;
• Understanding of the working environment /competitors;
• Technical competence in insurance;
• Basic knowledge of regulations by AKI and IRA;
• High emotional intelligence;

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PURPOSE:

Responsible for receiving and processing claims for provider payment.

PRIMARY RESPONSIBILITIES:

• Receive of claims- all claims received are well stamped and keyed in for future reference.
• Dispatch received invoices, mails and claim books to respective sections
• Respond to walk in customer enquiries
• Process, capture and authorize batched claims
• Scan prepared vouchers and reference to Document Management System
• Upload, attach and index relevant documents to vouchers to Document Management System
• Dispose claim documents as per approved disposal procedure

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s degree in Commerce or in a related field

Experience

• Up to one (1) years’ relevant experience

Skills and Attributes

• Excellent communication and presentation skills
• Problem solving skills
• Excellent interpersonal skills
• Excellent customer care skills
• Good analytical skills
• Computer literate in MS Office and other office applications

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PURPOSE:

To provide general customer service in respect to medical business customers.

PRIMARY RESPONSIBILITIES:

• Receive and respond to Medical emergency lines and ensure 24 hour coverage.
• Handle phone calls and visitors, as well as resolve customers’ communication through electronic and physical channels.
• Issuance of both in and outpatient approvals for admissible requests for insured members.
• Communication to stakeholders on management of cases and financial liability through reports.
• Provide input for the customer service reports.
• Handle customer service issues and queries.
• Escalate Customer queries to the relevant job role if necessary.
• Maintain professional ambience within the office premises.
• Promote the organization’s customer service charter.

GENERIC DUTIES

• Participate in planning and budgeting for the department.
• Support all Medical business events in both for internal events and those involving CIC Stakeholders and /or the general public;
• Participate in premium collection and renewal follow up for clients.

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s Degree In Nursing (KRCHN), Health Management Or In A Related Field
• Diploma in Nursing or Health System Management would be an added advantage

Professional Qualifications

• KRN/KRCHN

Experience

• Up to three (3) years’ relevant experience in busy health environment
• Experience in a medical call centre management unit will be an added advantage

Skills and Attributes

• Problem solving skills;
• Good analytical skills;
• Computer literate in MS Office and other office applications;
• Understanding of the working environment /competitors;
• Technical competence in insurance;
• Basic knowledge of regulations by AKI and IRA;
• High emotional intelligence;

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PURPOSE:

Responsible for vetting both in/ outpatient medical claims for payment.

PRIMARY RESPONSIBILITIES:

• Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor;
• Batch outpatient invoices on the system and adjust amount payable as per the vetting findings;
• Check and reject incomplete invoices and return with supporting documents to service providers;
• Negotiate, adjust and update service providers on their cost and accounts status;
• Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills;
• Review claims reserves on a continuous basis in view of new developments;
• Attend to customer queries and complaints promptly and professionally and
• Recommend risk improvement measures to the underwriter to take appropriate action.

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine

Professional Qualifications

• Kenya Registered Nursing (KRN) Diploma – Required

Experience

• Up to three (3) years’ relevant experience

Skills and Attributes

• Problem solving skills;
• Good analytical skills;
• Computer literate in MS Office and other office applications;
• Understanding of the working environment /competitors;
• Technical competence in insurance;
• Basic knowledge of regulations by AKI and IRA;