Sheila Mbogo
@sheilambogo
Experienced provider relations expert with a nursing background.
KenyaWhat I'm looking for
I am a seasoned provider relations expert with over 13 years of extensive experience in patient care, care management, medical underwriting, and wellness within the insurance healthcare industry. My journey has taken me through esteemed institutions such as The Mater Hospital, Madison Group, and AAR Insurance-Kenya, where I have consistently enhanced services and contributed to top-line growth. Renowned for my dynamism, attention to detail, and resourcefulness, I have developed a reputation for delivering exceptional care management solutions.
Throughout my career, I have successfully coordinated care management protocols, negotiated treatment rates, and implemented wellness programs that have significantly improved patient outcomes and satisfaction. My analytical proficiency and effective communication skills have allowed me to assess client risk profiles accurately and recommend appropriate insurance coverage. I am currently seeking a Care Manager position where I can leverage my expertise in medical insurance to drive innovative wellness programs and enhance provider relationships.
Experience
Work history, roles, and key accomplishments
Medical Claims Assessor
AAR Insurance Kenya
Feb 2024 - Mar 2024 (1 month)
Responsible for timely discharge and assessment of medical claims, highlighting fraudulent claims, and preparing reports on claims status. Assisted in reconciling provider statements and participated in project meetings.
Medical Underwriter/Wellness
AAR Insurance Kenya
May 2021 - Nov 2022 (1 year 6 months)
Assessed risk for corporate and retail clients, conducted underwriting for older clients, and organized wellness programs. Facilitated discussions on treatment compliance and coordinated underwriters meetings.
Care Manager
AAR Insurance Kenya
Apr 2016 - May 2021 (5 years 1 month)
Coordinated treatment protocols with providers, managed care management protocols, and provided quality customer care. Implemented disease management programs and prepared case management reports.
Care Manager
Madison Group
Sep 2013 - Dec 2015 (2 years 3 months)
Verified claims, provided technical expertise in case management, and organized health talks. Developed controls to minimize fraud and managed emergency lines.
Staff Nurse
The Mater Hospital
May 2011 - Aug 2013 (2 years 3 months)
Provided holistic nursing care to patients, developed care plans, and supervised nursing students. Maintained patient data and assessed treatment responses.
Education
Degrees, certifications, and relevant coursework
Nazareth Medical College
Diploma in Kenya Registered Community Health Nursing, Nursing
2011 -
Completed a Diploma in Kenya Registered Community Health Nursing (KRCHN), focusing on community health practices and patient care.
Kyeni Girls High School
Kenya Certificate of Secondary Education, General Education
2005 -
Completed K.C.S.E, which provided foundational education and skills necessary for further studies.
Tech stack
Software and tools used professionally
Availability
Location
KenyaAuthorized to work in
Job categories
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