Medical Service Manager at a Leading Health Insurance Firm – Brasenwall Professional Consultants (3 Openings)

Job Title: Medical Service Manager

Role Summary

• The Unit Lead, Medical Operations ensures that the unit meets its operational objectives as it relates to providers satisfaction, prompt payment of claims and medical utilization management.
• The Unit Lead, Medical Operation supervises the Team Lead, Claims and Team Lead, Provider/Case Management and also responsible and accountable to Management through the Head of Medical Operations

Specific Duities and Responsibilities

• Supervise and manage day-to-day itinerary of Case Managers
• Supervise and manage the day-to-day Case Management activities, utilization reviews, quality management activities and medical outreach or education programs
• Collate report of medical case reviews/audit, present findings, propose improvement plans and monitor strict execution of the improvement plans
• Collate report of utilization reviews, present findings, propose solution and monitor implementation of plans
• Collate report of accreditation and re-accreditation of providers and present findings for approval
• Co-ordinate and collate report of claims reconciliation with providers, present findings and resolutions and monitor execution of resolutions as well as collection of Letters of Non-Indebtedness (LONI)
• Co-ordinate the collation of regulatory report including monthly Fee-For-Service FFS) and Referral report,
• Quarterly Provider Sensitization and Itinerary report
• Co-ordinate the Pharmacy Benefit Program (Pharm-Assist) to manage medical cost from drugs (medications) without compromising client convenience
• Co-ordinate Medical Referral program to manage medical cost without compromising client convenience
• Co-ordinate the Claims Administration team to ensure prompt claims processing and payment to providers in line with the organization’s contract with the providers
• Manage high level relationships within every healthcare facility to ensure continued high quality service delivery
• Coordinate the prompt resolution of all escalated provider or claim grievance issues
  Monitor and evaluate the day-to-day performance of the Case Managers and Claims Adjusters.

Requirements

• Experience Required: Minimum 4 years
• Education Level: MBBS
• Experience: Clinical Experience with HMO background will be an advantage
• Minimum of a first degree in Medicine
• Experience in the healthcare industry is an added advantage.
• Basic proficiency in the use of Microsoft Office tools
• Excellent communication skills.

Application Instructions:

The application deadline is Not Specified. Therefore, qualified and interested candidates should send their updated Resume to: [email protected] and copy: [email protected] using the Job Title as the subject of the email.

Note: Only qualified candidates will be contacted. It is important to visit the official website (link found below) for detailed information on how to apply successfully

Official Job Website: https://www.brasenwall.com/