Case Management Executive (x4) at Strategis Insurance Tanzania Limited February 2024, Jobs Case Management Executive (x4) Expected appointment date: Immediately
Division: Medical Insurance
Department: Business Development – Business Retention
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Location: Lake Zone, Northern Zone, Southern and Highland Zone, Dar es Salaam
Main tasks:
- Ongoing interventions in the provision of care directed at ensuring quality and cost efficiency of the services delivered by our upcountry providers.
- To ensure all pre-authorisation/approvals for inpatient admissions, high cost outpatient claims and major procedures are done appropriately and on time.
- Visiting members in hospital for case management activities where it is checked that the healthcare is delivered at affordable cost, in line with the members’ benefits plus eligibility, severity of disease, appropriateness of level of care and discharge planning.
- Approval of domestic referrals where required and advise on per diem based on distance and location.
- Arranging for admission of members referred from upcountry including facilitation of evacuation.
- Ongoing communication intervention and maintenance of good relationships with Strategis providers.
- In collaboration with other departments, maintaining good relationships with health care providers.
- Initiating, re-negotiating and finalizing the price list review, average cost and discount for upcountry provider.
- Maintaining and Monitoring upcountry Providers accounts and rejection reconciliations not limited to timely submission of claims and timely payments.
- Training of upcountry providers.
- Following up on sign off and no due letter for upcountry providers.
- Prepare monthly report.
General Performance Standards:
- Develop ability to work without constant direct supervision.
- Maintain a positive attitude and contribute toward a quality work environment.
- Assist in all areas of Strategis operation as requested by Management.
- Communicate to management any and all occurrences Strategis clients or providers.
Other Tasks:
- To perform any other duties delegated by any up-line manager.
Skills and Competencies:
- Flexibility
- High Integrity
- Honest
- Skills on convincing and negotiation.
- Ability to work under pressure.
- Ability to combine multiple resources to resolve claims issue.
- Ability to work independently or as a part of a team to meet Company’s expectation.
- Strong computer skills e.g. internet/web, MS Office (Word, Excel, Outlook)
Education including specialized training:
- Qualification in the medical field (Medical Officer, Nursing Officer, AMO, CO).
- COP certificate in Insurance or Diploma in Insurance will be an added advantage.
- Computer Literate.
Work Experience:
- One years’ experience in local hospitals or clinics OR medical insurance with experience in discharging at least four of the responsibilities mentioned above.
Mode of Application:
All applications should have names of three official referees with their contact detail. Applications accompanied by professionally prepared CVs, copies of all supporting documents along with a recent passport size photograph should be submitted not later than 13 February 2024 to the following address.
Head of Human Resource and Administration
Strategis Insurance Tanzania Limited
- O. Box 7893 Dar es Salaam, Tanzania
E-mail: hr@strategis.co.tz
Or delivered to:
Strategis Insurance Tanzania Limited
1st Floor, Masaki Ikon Building Plot no. 1520, Bains Avenue Masaki, Msasani Peninsular
Note: Only shortlisted candidates will be contacted.
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