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

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

Jobs at:
Britam

Deadline of this Job:
Tuesday, July 1 2025

Duty Station:
Nairobi | Nairobi | Kenya

Summary
Date Posted: Tuesday, June 24 2025, Base Salary: Not Disclosed

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JOB DETAILS:

Job Purpose:

• Reporting to the Manager Clinicals, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

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.
• 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.
• Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
• Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Prepare periodic reports for management on medical claims.
• Ensure claims are processed within the stipulated time.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Score Card.

Knowledge, experience and qualifications required

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
• 3-6 years’ experience in case management.
• Proven experience in managing and nurturing client relationships.
• Track record of achieving client satisfaction and retention targets.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.

Work Hours: 8

Experience in Months: 36

Level of Education: bachelor degree

Job application procedure

Interested and qualified? Click here to apply

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