Ensure that services are rendered according to approved protocols and in the appropriate levels of care, including but not limited to checking and confirming member eligibility, benefits and the verification of exclusions;

Ensure the appropriate use of facilities and services best suited to the clinical needs of each client/product;

Accurate coding of proposed treatment using relevant coding structures.

Maintain and improve the quality of care through reviewing procedures, protocols and Service Level Agreements (SLAs) as well as the appropriateness of services requested;

Liaise with providers to co-ordinate concurrent review and case management process;

Plan, develop and organize Service provider Seminars to engage with profiles towards optimum service quality;

Initiate and managing the inpatient/discharge verification;

Dvelop processes and Implement the managed care component of Metropolitan Health Insurance service delivery module;

Build and maintain relationships with clients and stakeholders;

Identify, recruit, grow and retain potential and existing clients;

Identify solutions to enhance cost effectiveness and increase operational efficiency;

Accurate data collection, reporting and interpretation;

Ensure Service provider outlets are visibly merchandized;

Liaise with external service providers as well as internal hospital benefit management consultants as required;

Perform any other task assigned by Supervisor within scope and content of job

Requirements 

At least a first degree in related field from a recognized university.

2-3 years’ work experience in a similar environment will be an advantage

Competence 

Business Acumen

Client/Stakeholder Commitment

Collaboration

Impact and Influence

Self-Awareness and Insight

Diversity and Inclusiveness

Drive for Results