1. MAIN PURPOSE OF THE JOB (overall)
To provide clinical care to the capitation clients as part of a multidisciplinary care process leading to desired patient care outcomes, service standards, and best practice standards.
Key roles;
The Care Officer will be responsible for day-to-day liaison with the Company’s capitation clients by implementing quality standards and ensuring that all services meet the clients’ needs and expectations.
Duties:
a) Participate in the formulation, dissemination and implementation of capitation services
b) Enroll and maintain an up-to-date database of all capitation clients
c) Handle all communications to capitation clients whether through telephone, e-mail, letters and face-to-face
d) Resolve any issues raised by clients in a timely manner which include communicating on held / declined claims
e) Liaise with other officers in customer care, finance and clinical departments to ensure efficient service provision to clients and service providers
f) Compile trend reports on the clients based on performance and clinical audit
g) Make hospital visits to all admitted patients
h) Confirm receipt of claims, evaluate and validate them
i) Keep an updated benefit schedule and details often communicated to scheme users
j) Maintain an updated care protocol
k) Liaise with accounts department for timely payments to service providers
l) Assess service requests and provide pre-authorization
m) Often provide training on the scheme to the clients
n) Any other duties that may be assigned to you from time to time
2. EDUCATION AND RELEVANT EXPERIENCE
a) Formal Academic and Professional Education:
(i) Undergraduate degree/diploma in a health-related field
(ii) Post graduate certification in a business-related field
b) Skills and Relevant Experience:
(i) A minimum of 3 years’ work experience in health care service delivery
(ii) 2 years experience in a similar capacity
(iii) Computer Knowledge – Microsoft Word, Excel, Power Point
(iv) Excellent people management skills and interpersonal skills and high integrity
(v) Self-motivated and proactive with ability to work under minimal supervision
(vi) Excellent oral and written communication skills
3. KEY PERFORMANCE INDICATORS
a) Timely resolution of client complaints
b) Updated and standardized database of capitation clients
c) Provision of accurate information on capitation clients
d) Quality standards implemented across all service providers
If qualified, kindly send your CV to jobs@jantakenya.com clearly indicating ‘Care Officer’ on the subject line by 8th June, 2015. DO NOT attach any certificates.
Only shortlisted candidates shall be contacted