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Full-time
Assistant Case Manager Job at PACIS Insurance
PACIS Insurance
Job Description
The Assistant Case Manager at PACIS Insurance facilitates quality healthcare services by collaborating with clients, intermediaries, and medical service providers. The role focuses on processing medical claims, managing inpatient and outpatient cases, and implementing cost containment strategies. This position is vital for ensuring business growth, profitability, and customer retention within the insurance medical benefits department.
Duties, Roles and Responsibilities
- Confirmation of membership, validity, and benefits before processing claims.
- Capture and vet medical bills within the client's benefit structure and as per negotiated customary, reasonable rates.
- Correctly reserve inpatient bills on discharge and approved outpatient cases.
- Preparing and sending the correct reimbursement remittances to clients.
- Communicating any claim dispute or rejection to the clients and intermediaries.
- Receive and respond to medical emergency lines and ensure 24-hour coverage.
- Issuance of both inpatient and outpatient approvals for admissible requests for insured members.
- Communication and notification to stakeholders on management of cases, discharges, admissions, and financial liability
- Coordinate with the clients and medical providers to leverage on SHA rebates and packages.
- Negotiation of hospital and doctors' charges with the aim of optimal cost containment before or during admissions.
- Weekly running and sending out active members list to preferred panel of providers.
- Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi.
- Resolve all customer queries immediately and promptly escalate complex cases
- Send weekly and monthly reports on admissions, exceptional claims, long stay, savings, claims production amongst others.
Qualifications, Education and Competencies
See all details of the qualifications, competencies and education for this role under the "How to Apply" section below.
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