Summary
Date Posted: Friday, May 06, 2022 , Base Salary: Not Disclosed

JOB DETAILS:
Care Manager-Nurse-2 First Assurance
Job Summary
Case management, handling all outpatient, inpatient, specialized services preauthorization, and Communicating with providers, clients and brokers on a timely basis

Job Description
• Manage 24 hour call centre
• Prompt response to emails, admissions requests.
• Critical analyzation of all medical requests from service providers.
• Efficient & accurate submission of approvals in line with the medical policy .
• Obtaining medical information from providers with written correspondence if necessary.
• Capacity to continually apply negotiation skills with the service providers
• Interacting with clients, Intermediaries and services providers as required to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
• Accurate checking and confirming membership validity, benefits and sending member statement upon enquiry.
• Accurate guidance on provider network enquiries from brokers, providers, members etc.
• Vetting and confirming validity of the service given by the service provider in relation to the member benefit covered, treatment given, adherence to provider panel rules and cost of treatment
• Obtaining additional required information on invoice/claims from providers or clients.
Education
• Further Education and Training Certificate (FETC): Business, Commerce and Management Studies (Required)

Job Experience: No Requirements

Work Hours: 8

Level of Education: Professional Certificate

Job application procedure
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