Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. The group offers a wide range of financial products and services in Insurance, Asset management, Ban...
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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.
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