ROLE PURPOSE
The Assistant Care Manager is responsible for Care Management by following up members undergoing in patient care and reporting to the care management team.
KEY DELIVERABLES
• Review medical claims for compliance with applicable policy guidelines
• Interact with clients, brokers and clinicians as needed, to resolve problems in manner that is legal, ethical and consistent with principals of the policy.
Obtain medical information from providers telephonically during initial contact, during visits and follow up with written correspondence if necessary.
• Participate in care management meetings.
• During claim approval and second checking, confirm and ensure that accurate claim details are captured from the claim documents into ACTISURE by Registrars.
• Check and confirm membership validity and benefits (from the scheme benefits file)
Handling of coverage enquiries with brokers, providers, members etc.
• Vet and confirm validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
• Help in obtaining additional required information on claims from providers.
• Check and confirm any advice by the registrar on any relevant information noted on claims during claim approval or second checking.
• Liaising with the underwriting team on scope of cover for various schemes.
• Pre-authorize services that require prior approval from Jubilee Health.
• Manage 24-hour emergency help line.
• Any other duties that may be assigned by the Line Manager/ supervisor from time to time.
KEY COMPETENCIES
• Must be a critical thinker
• Team player
• Excellent interpersonal and communication skills
• Keen attention to detail
QUALIFICATIONS
• Degree in Clinical studies / Medical Course or any related course.
• Good understanding of the concepts of medical insurance
• Mature, team player with supervisory skills
• Proficient in the use of Microsoft office suite and packages
• Quick at learning the current Medical System
RELEVANT EXPERIENCE
• Minimum of Two (2) years’ experience.
• Experience in Claims Approval is an added advantage.
If you are qualified and seeking an exciting new challenge, please send your application, CV together your academic documents as one document either in PDF or Word Format to jhicu-recruitment@jubileeuganda.com quoting clearly the Position in the subject line note later than 5:00 PM on Monday 22nd January, 2024.
Only shortlisted candidates will be contacted.