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.
