Our client a hospital in Nairobi is seeking to Care Officer urgently. Main Purpose of the Job (Overall): To provide clinical care to the capitation clients as part of a multidisciplinary care process leading to desired patient care outcomes, service standards, and best practice standards.
Key Roles: The Care Officer will be responsible for day-to-day liaison with the Company’s capitation clients by implementing quality standards and ensuring that all services meet the clients’ needs and expectations.
Duties:
- Participate in the formulation, dissemination and implementation of capitation services
- Enroll and maintain an up-to-date database of all capitation clients
- Handle all communications to capitation clients whether through telephone, e-mail, letters and face-to-face
- Resolve any issues raised by clients in a timely manner which include communicating on held / declined claims
- Liaise with other officers in customer care, finance and clinical departments to ensure efficient service provision to clients and service providers
- Compile trend reports on the clients based on performance and clinical audit
- Make hospital visits to all admitted patients
- Confirm receipt of claims, evaluate and validate them
- Keep an updated benefit schedule and details often communicated to scheme users
- Maintain an updated care protocol
- Liaise with accounts department for timely payments to service providers
- Assess service requests and provide pre-authorization
- Often provide training on the scheme to the clients
- Any other duties that may be assigned to you from time to time
Education and Relevant Experience
Formal Academic and Professional Education:
Formal Academic and Professional Education:
- Undergraduate degree/diploma in a health-related field
- Post graduate certification in a business-related field
Skills and Relevant Experience:
- A minimum of 3 years’ work experience in health care service delivery
- 2 years experience in a similar capacity
- Computer Knowledge – Microsoft Word, Excel, Power Point
- Excellent people management skills and interpersonal skills and high integrity
- Self-motivated and proactive with ability to work under minimal supervision
- Excellent oral and written communication skills
Key Performance Indicators
- Timely resolution of client complaints
- Updated and standardized database of capitation clients
- Provision of accurate information on capitation clients
- Quality standards implemented across all service providers
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