SM
Open to opportunities

Sheila Mbogo

@sheilambogo

Experienced provider relations expert with a nursing background.

Kenya

What I'm looking for

I am looking for a role that fosters innovation in wellness programs and enhances provider relationships.

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

AK

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.

AK

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.

MG

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.

TH

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

NC

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.

KS

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

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Sheila Mbogo - Medical Claims Assessor - AAR Insurance Kenya | Himalayas