Job Responsibilities
Attend to and resolve all enrollees’ enquires and ensure that all complaints are promptly resolved on first call resolution, or immediately escalated to the appropriate group or unit.
Meticulously log all for management analysis and documentation for all relevant stakeholders.
Follow-up on specific cases as assigned by the line manager for measurable outcomes and stakeholders’ satisfaction.
Actively and proactively engage in the vetting of bills from the organization’s network of facilities providing secondary/tertiary healthcare services on the public sector social health insurance program
Benchmark all received claims with the pre-authorized codes given by call center as any service provided by any facility without pre-authorized code is considered null and void.
Review all the received bills and possibly contact the enrollees for authorization of services provided.
Investigate and report any incident of abuse, neglect or maltreatment of enrollees immediately to the Management for appropriate actions to be taken.
Follow up on enrollees on admission in order to evaluate and document their progress and possibly assist the care team with developing and accessing health interventions.
Participate in case management through scheduled and unscheduled visitation to enrollees on admission.
Graduate Professional Nurse and First Degree from an accredited Baccalaureate Nursing Program (University)
Must be a registered and licensed practitioner.
Possession of recognized additional training in primary health care and midwifery is desirable.
Experience:
Applicants must have minimum of 2 years’ experience as a Nurse and Midwifery Professional.
Ability to work seamlessly with Computer and other communication equipment and software.
Interested and qualified candidates should send their CVs to recruitment@stresertintegrated.com using QAN-BEN-24 as subject of the mail.
Apply via :
recruitment@stresertintegrated.com
