Consultant Care Management

ABOUT ZAMARA
The Zamara Group is a diversified financial services business specialising in pensions, medical services, insurance and actuarial solutions. Headquartered in Nairobi, Kenya, the Group has a presence in eight countries and a Pan-African ambition. Zamara has a rich heritage in Kenya spanning over 30 years.
Since its inception, the firm has significantly grown in terms of size, client base and range of services. The Group has been at the forefront of industry, influencing the way it works and at the cutting edge of innovation.
Zamara’s higher purpose is to create a financially secure and prosperous society. The Zamara culture is based on the values of Simplicity, Empathy and Trust.
KEY ROLES AND RESPONSIBILITIES
Achieving Zamara’s ambitious strategic priorities will be complex and challenging. Its continued success will be dependent on building and retaining a world-class team.
The Assistant Consultant will ascertain seamless service delivery to clients by offering support and assistance to medical insurance policy holders through the claims & call centre and at medical facilities, with minimal inconvenience, while supporting the overall goal of client satisfaction.
This role reports to the Manager, Care Management.
KEY RESPONSIBILITIES
Care Management
Manning calls on the 24-hour medical emergencies help lines
Facilitate approval and authorisation for Emergency Inpatient hospitalisation e.g. post road traffic accidents from the insurance companies/underwriters.
Outpatient treatment authorisation (off smart/ no card)
Facilitate evacuation processes to ensure favourable outcomes and reasonable charge to clients.
Preauthorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
Liaising with the Insurance companies in the process of undertaking and pre-authorizations.
Provider panel management – ensuring required facilities are onboarded and favourable relationship is always maintained.
Advocating for clients
Negotiation of borderline claims
Support with overseas referral
Offer dedicated services to clients at their premises.
Reporting
Provide data reports collected from various monitoring tools assigned to the role e.g. weekly and/or monthly reports.
Trend analysis – hospital charges, cost of various packages etc
Value Adds
Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge.
Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers.
Issuing Zamara gift packs - pack of diapers, branded get well / birth congratulations to admitted patients.
SKILLS AND QUALIFICATIONS
A Diploma in Nursing Sciences/ Clinical medicine
Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
General understanding of the insurance industry is an added advantage.
Capacity to build relationships
Business etiquette
Excellent interpersonal and customer service skills
Team player
Problem Solving skills
Self-Driven
Flexible to train

Employment type
Fixed Term Contract

Work arrangement
No