Care Officer Ãâ¢ã‚â€ã‚â“ Microinsurance

About the Role

Reporting to the Assistant Manager Care Management, the role holder will ensure the efficient and effective management of insured members' medical care by overseeing approvals, coordinating treatment processes, and monitoring benefit utilization in line with the organization's policy guidelines, while delivering high-quality customer support.

Key Responsibilities:

• Issue medical approvals for insured members seeking both inpatient and outpatient services, in accordance with the applicable policy terms.
• Monitor inpatient admissions, focusing on treatment costs and average length of stay, to ensure cost-effective care.
• Provide pre-authorization guidance for scheduled procedures, including optical and dental services.
• Conduct daily hospital visits to support insured members during hospitalization and ensure quality care delivery.
• Respond promptly and professionally to stakeholder inquiries regarding medical care management cases.
• Receive and respond to medical emergency calls through the 24-hour call center, ensuring compassionate, accurate, and timely assistance to clients and healthcare providers, with a strong emphasis on customer care and service excellence.
• Negotiate discounts with healthcare providers (doctors and hospitals) for specific procedures or high-cost cases as needed and coordinating with clients and medical providers to leverage on SHA/SHIF packages.
• Facilitate medical referrals and emergency evacuations when required, ensuring timely coordination and communication.
• Monitor the utilization of member benefits and share regular updates and insights with internal and external stakeholders.
• Prepare and submit accurate, timely reports as directed by management or policy guidelines.
• Review medical reports and laboratory results to assess clinical risk and provide informed recommendations to support the underwriting team in evaluating acceptance risk.

Who We're Looking For

Essential Knowledge/Skills and Experience Required:

• Bachelor's Degree/ Diploma in Nursing, clinical medicine or healthcare related field
• Minimum of 3 years of experience