SKILLS AND COMPETENCIES**
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Excellent communication and negotiation skills
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Excellent public relations and interpersonal relationship skills
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Extensive networking with SP and other medical insurers
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Excellent analytical and monitoring skills
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Good IT skills in database management and office systems
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Good decision making in benefit utilization management
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High levels of integrity and honesty
- QUALIFICATIONS, KNOWLEDGE & EXPERIENCE **
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Diploma or Degree in Nursing
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Diploma in Insurance/ COP
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Degree in Health systems Management/ Business management
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3 years’ experience in clinical setting +2 years in insurance set up
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Pre-authorize scheduled and non-scheduled admissions within the set guidelines
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Negotiate/discuss professional fees as appropriate for each admission
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Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
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Visit all admitted clients within Nairobi region and its environ
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Liaise with Doctors on the day-to-day management of patients and obtain medical reports/ expected length of stay where indicated
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Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care
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Revise reserves after discharge of member
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Collect feedback from admitted clients on quality and scope of service by the service provider
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Assist in carrying out verification and medical audit of claims/invoices before settlement
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Develop and maintain monthly database on admissions, large claims and extended length of stay.
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Respond to queries from clients, intermediaries and service providers
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Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products
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Any other duty assigned by management