Essential Knowledge/Skills and Experience Required:

• Diploma in Optometry and Vision Sciences
  
• Licensed by KHPOAP
  
• Minimum of 3 (three) years relevant experience in a busy medical environment
  
• Experience in an insurance firm is an added advantage
  
• Customer experience training will be an added advantage
  

Key Competencies:

• High attention to detail and accuracy
  
• Analytical & problem – solving
  
• Good communication and stakeholder management skills.
  

• Accurate adjudication of all Optical claims in accordance to Scheme’s policy provisions.
  
• Maintenance of high servicing levels by issuing approvals within 15minutes and sharing daily optical TAT report
  
• In-depth analysis of claim trends and maintenance of accurate revisit registers
  
• Respond to Optical related calls and email complaints within 24hours of notification and timely escalation as per escalation matrix
  
• Facilitate issuance of letters of undertaking for scheduled ophthalmological procedures and cases requiring day case and inpatient ophthalmology care
  
• Institutionalize robust optical and ophthalmological cost management initiatives through discount negotiation, fraud detection and investigation, costing, and optimization of SHA ophthalmological packages.
  
• Conduct cost versus clinical validation of optical prescriptions, lens and frames choices, diagnoses requirements to prevent inappropriate costing, or incongruent prescriptions.
  
• Conduct regular Optical provider forensic mystery shopping and physical audits of at least 5 providers quarterly and share audit report with management.
  
• Negotiate at least 5 preferred Opticians per quarter and help drive traffic to the preferred panel
  
• Any other duty as may be assigned by the supervisor.