Vacancy title:
Case Management Officer (Fixed-Term Contract)

[Type: FULL_TIME, Industry: Investment, Category: Healthcare]

Jobs at:
Britam

Deadline of this Job:
Monday, July 7 2025

Duty Station:
Kenya | Nairobi | Kenya

Summary
Date Posted: Wednesday, June 18 2025, Base Salary: Not Disclosed

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JOB DETAILS:

• Controlling and Managing policies through case management to ensure quality and cost effective healthcare, client service, provider management, processing provider claims and clients for payment.

Key Responsibilities:

• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Interact with clients and service providers to ensure that the care is given within policy guidelines.
• Review medical reports and claims for compliance with set guidelines.
• Process claims and claims vetting.
• Liaise with underwriters on scope of cover for the various schemes.
• Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
• Discourage poly-pharmacy by diligently challenging of prescriptions and suggesting better alternatives as per medical practice.
• Encourage use of generics and cost effective quality drugs where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Review documents and pertinent requirements regarding claims from providers and clients.
• Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements of an insurance claim.
• Management of relationships with clients, intermediaries and service providers.
• Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate risk.
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claims inquiries concerning claims process, service providers, and the filing/completion of proper forms.
• Record all claims transactions.
• Prepare claims registers for claims meetings and update the various claims reports.
• Track and follow up on receipt of necessary documents.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required

• Degree in Bachelor of Science in Nursing Sciences from a recognized university.
• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least two-year experience in case management and claims processing.

Work Hours: 8

Experience in Months: 24

Level of Education: bachelor degree

Job application procedure

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