Jobs at Old Mutual Kenya

The Health navigation officer reporting to the Wellness lead will be key in the review of health trends across the various customer segments within the medical business, with an aim of designing programs/initiatives that promote high quality service delivery, cost effective benefit utilization and desired preventive/curative wellness and  business outcomes.

Key Responsibilities:

• Execute designed wellness programs tailored to clients' needs, including fitness, nutrition, mental health, and stress management initiatives.
• Facilitate the adoption and utilization of Old Mutuals digital wellness platform by our customers to offer holistic wellness solutions and drive customer engagement.
• Roll out wellness awareness initiatives such as health literature, webinars, health talks and relevant events.
• Monitor health-seeking trends across our corporate and retail customer base with the aim of supporting clients in effective utilization of wellness-related benefits to promote overall population health/wellbeing and cost effectiveness
• Assist clients in navigating the healthcare system, including connecting them with appropriate healthcare providers and understanding their health benefits.
• Engage with customers and intermediaries on various forums to raise awareness and utilization of wellness initiatives and drive appropriate health behavior change
• Collaborate with healthcare providers and wellness experts to offer accessible and affordable comprehensive wellness solutions.
• Monitor and analyze wellness program outcomes, preparing reports and recommendations for areas of improvement.
• Conduct workshops, seminars, and training sessions to educate clients and employees on wellness topics.
• Stay updated on industry trends and best practices in wellness and insurance.
• Monitor data to ensure healthcare utilization and desired outcomes are met.
• Ensure compliance with regulatory requirements related to wellness programs and insurance services.
• The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.

Qualifications:

• Bachelor’s degree in health sciences, Insurance, or a related field.
• At least 2 years of experience in a clinical or digital health setting. Health insurance experience is an advantage.
• Strong interpersonal and communication skills.
• Experience in designing and managing wellness programs.
• Knowledge of insurance policies and wellness benefits.
• Proficiency in health navigation, including connecting clients to healthcare resources.
• Analytical skills to assess program effectiveness and make data-driven decisions.
• Proficiency in reporting across various stakeholder segments.

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To assist in processing of medical claims with a focus on cost control and management of member benefits through linking and coding of inpatient and outpatient bills and capturing in the company medical business operating system(s).

KEY TASKS AND RESPONSIBILITIES

• Reviewing and processing general insurance claims and giving recommendation on settlement or repudiation.
• Capturing of claims as per set rules/guidelines and validate a claim against policy / scheme / guidelines, agreed etc.
• Organizing trainings on document uploads in liaison with key partners and ensuring compliance with the corporate document management policy
• Clean up of the medical claims electronic data management system to ensure an efficient document management system.
• Proactive management of member benefits and reporting of any unusual trends as per the agreed SLA with suppliers and partners.
• Offer Resolution of any missing information required to fully capture a claim by reaching out to the finance payables team.

SKILLS AND COMPETENCIES

• Computer skills
• Good Customer service
• Good Analytical Skills

KNOWLEDGE & EXPERIENCE

Qualifications:

• Qualification- Bachelor’s degree in any medical related fields, Insurance field or Business field.

Experience:

• 1-2 years