Case Management Officer

14 hours ago

Nairobi, Nairobi Area, Kenya Britam Full time 900,000 - 1,200,000 per year

Job Purpose
To oversee and coordinate all pre-authorization, admission, discharge, and care coordination activities, ensuring quality patient care while managing medical costs and provider relationships effectively.

Key Responsibilities

  • Oversee medical case management and pre-authorizations.
  • Ensure timely and appropriate approvals for inpatient and outpatient services.
  • Collaborate with hospitals, TPAs, and providers to ensure quality care delivery.
  • Monitor and track high-cost cases, chronic illnesses, and frequent claimants.
  • Offer clinical guidance to underwriters and claims analysts on complex cases.
  • Train and mentor staff and ensure process adherence.
  • Maintain and update provider tariff lists and treatment protocols.
  • Support fraud detection and provider performance reviews.
  • Stay updated on industry trends, emerging risks, regulatory changes, and new technologies that could affect underwriting practices.
  • Deliver on performance requirements as defined in the departments' strategy map, balanced scorecard and Personal Scorecard.
  • Perform any other duties as may be assigned from time to time

Knowledge, Experience And Qualifications Required

  • Bachelor's Degree or Diploma in Nursing, Clinical Medicine, or related health field.
  • 2-4 years' experience in medical case management in the insurance sector.
  • Strong clinical knowledge and experience managing medical claims or provider relations.
  • Excellent communication and decision-making skills.
  • Ability to work under pressure and coordinate with multiple stakeholders.
  • Experience in customer, market and competitor understanding.
  • Knowledge of Insurance regulatory requirements.

Primary Location
Kenya-Nairobi-Nairobi

Organization
Britam

Job Type
Permanent

Shift
Day Job

Contract Type
Full-time

Job Posting

Unposting Date
Ongoing

Number of Openings
2

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