Ros Toroitich

With acquired knowledge skills and innovative ways be able to solve problems affecting the community and achieve growth in the dynamic world of medical profession.

COUNTY SCHEME MANAGER - Minet insurance company

(2017-03 - 2022-11)

• Making visits to clients admitted in facilities and initiating stepdown if need be.
• Improves financial status by analysing results; monitoring variances; identifying trends. recommending actions to management.
• Meets budget by monitoring expenses, implementing cost-saving actions.
• Prepares reports by collecting, analysing, and summarizing treatment and results data and trends; compiling statistics; completing grant and subsidy applications.
• Handled the tasks of responding to customer queries, patient care and assured that the complaints are handled in accordance with legal compliance
• Promoted company standards of quality and contributed to the overall growth of the organization
• Member education and sensitization about the scheme benefits
• Organizing wellness programs for members
• Organizing and conducting stakeholder meetings within the county
• Report writing
• Incidence reporting within the county
• Participation in service provider contractual processes and surgical package agreements.
• Assist new Members and dependents registrar into the scheme
• Follow up of patient on chronic diseases management program
• Participation in company growth by identifying and bringing in new business
• Curbing and flagging any fraud cases using the available fraud reporting systems
• Training of service providers on communication systems on authorization requests and document submission.
• Facilitating evacuation of patients' who need special treatment outside the country
• Organizing ambulances for emergency cases within the county
• Assist in providing information and documents for deceased member for payment of last Expense and group life claims to the respective next of kins.
• Orientation and training of new staff deployed into the company.
• Coordinating with other county scheme managers to ensure seamless transfer of patients who need care in another county/regions
• Vetting of hospital bills before issuance of final approval.
• Claim assessment before forwarding to accounts department for payment.
• Capturing client queries on the ticketing tool.

CLAIM ASSESSOR - Jubilee Insurance Company Limited

(2017-01 - 2017-09)

Processes medical claims and assures proper payment in accordance with the benefit plan

• Validating the information of patients on all medical claims from service providers seeking payment from the insurance company.
• Accurately entering data on the system for Outpatient claims.
• Assessment of medical claims before forwarding in for approval.
• Entering claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.
• Meeting quotas in terms of quantity and quality of claims processing standards.
• Independent and timely processing of claims in accordance with client requirements, member plan benefits, and applicable network fee schedules with minimal assistance.

TRIAGE NURSE - savanna healthcare

(2016-01 - 2016-08)

• Gathering client's information to create hospital file in the system and transmit it to the next medical personnel in the line.
• Establish priorities of patients care for urgent treatment while allocating scarce resources.
• Cleaning and dressing of wounds
• Maintaining proper supply of equipment in the facility by keeping proper records.
• Administering medications prescribed by the doctor.

Diploma - nursing - Kenya medical collage Nyeri (2011-09 - 2015-03)

Secondary Education - Sing'ore girls' high school (2007-01 - 2010-11)

Primary Education (1998-01 - 2006-11)