Corporate Care Management Associate

Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost-effective care.

Key Responsibilities

• Set the appropriate parameters for each admission (claim reserve, initial authorized cost, and duration)
• Interact with clients and service providers to ensure that the care is given within policy guidelines
• Review medical reports and claims for compliance with set guidelines
• Liaise with underwriters on the scope of cover for the various schemes
• Ensure that medical scheme members are attended to round the clock with support from the 24-hour call center.
• Poly-Pharmacy – discourages poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
• Generic substitution – Encourage the use of generics was indicated as a method of reducing the organization's pharmaceutical expenditure.
• Delegated Authority: As per the approved Delegated Authority Matrix
• Prepare periodic reports for management on medical claims
• Ensure claims are processed within the stipulated time
• Perform any other duties as may be assigned from time to time

Key Performance Measures

• As described in your Personal Score Card

Knowledge, Experience And Qualifications Required

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Moderate understanding of insurance concepts
• Professional qualification in FLMI, ACII and IIK.
• 5-8 years’ experience in case management two of which should be in a supervisory position

Leadership category responsibility framework (Core Competencies

Emerging Leaders In Britam Need To

• Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost, and team targets;
• Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation;
• Ensure that department priorities are adhered to and effectively communicated;
• Ensure competent and effective people resources through appropriate coaching, development, and people supervision as appropriate;
• Embody a high-performance, proactive culture;
• Effectively ensure the adherence to key performance areas, deadlines, and goals in order to optimize operational effectiveness;
• Effectively communicate resource needs, possible opportunities, and achievements to management in order to aid them in their decision-making;
• Effectively set and monitor priorities and objectives for more junior staff;
• Understand and communicate objectives in relation to the larger organizational impact;
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management;
• Appropriately model the company values while setting the pace and energy for delivering;
• Effectively manage and communicate change within the department in order to increase staff and process effectiveness;
• Provide access to accurate and consistent information and services across all channels;
• Ensure a seamless experience for clients;
• Improve service delivery for clients;
• Engage in continuous brand building to become the trusted partners of clients

Emerging Leaders Competency Descriptions.

• Presenting and Communicating Information - Speaks fluently; expresses opinions, information, and key points of an argument clearly; presents effectively; responds quickly to others ‘reactions and feedback during conversations; projects credibility.
• Working with People - Shows respect for the views and contributions of team members; shows empathy; listens, supports, and cares for others; consults others and pro-actively shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the team and fits in well.
• Adhering to Principles and Values - Upholds and encourages ethical behavior and departmental values; demonstrates integrity; encourages individual responsibility towards the community and the environment; models the organizational values during everyday interactions.
• Analyzing - Analyses numerical data and all other sources of information, breaking them into component parts, patterns and relationships; probes for further information or greater understanding of a problem; make rational judgments from the available information and analysis; demonstrates an understanding of how one issue may be part of a much larger system/process/problem.
• Planning and Organizing - Adheres to and monitors clearly defined objectives; plans activities and projects well in advance and takes account of possible changing circumstances; identifies and organizes resources needed to accomplish tasks; manages time effectively; monitors performance against deadlines and milestones.
• Delivering Results and Meeting Customer Expectations - Focuses on customer needs and satisfaction; sets and models high standards for quality and quantity; monitors and maintains quality and productivity; works in a systematic methodical and orderly way; consistently achieves projects goals.
• Deciding and Initiating Action - Takes responsibility for own, as well as subordinates’ actions and projects; takes initiative and works under own direction; initiates and generates activity; introduces improvements into work processes; handles problems with minimal guidance.
• Leading and Supervising - Provides subordinates with a clear direction; motivates and empowers others; provides subordinates with the relevant coaching; creates a positive climate that fosters learning and development; identifies high potential talent; sets and articulates the departmental vision and values through own personal behavior; set appropriate standards of behavior.
• Formulating Strategies and Concepts - Works strategically to realize personal goals; understands and effectively communicates the departmental strategy; translates the departmental strategy and vision into operational responsibilities; takes into consideration departmental strategy during all tasks; takes account of a wide range of issues across, and related to the current role.
• responsibilities; takes into consideration departmental strategy during all tasks; takes account of a wide range of issues across, and related to the current role.
• Applying Expertise and Technology - Applies specialist and detailed technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organizational departments and functions.
• Following Instructions and Procedures - Challenges authority only when appropriate; follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates a commitment to the organization; complies with legal obligations and safety requirements of the role.
• Adapting and responding to change - Adapts to changing circumstances; tolerates ambiguity; accepts new ideas and change initiatives; adapts interpersonal style to suit different people or situations; shows an interest in new experiences.

Technical/ Functional competencies

• Knowledge of insurance regulatory requirements
• Knowledge of insurance product
• Sales and marketing management skills