Case Management Officer job at Britam
Website :
21 Days Ago
Linkedid Twitter Share on facebook

Vacancy title:
Case Management Officer

[ Type: FULL TIME , Industry: Banking , Category: Finance, Insurance & Real Estate ]

Jobs at:


Deadline of this Job:
24 March 2023  

Duty Station:
Within Kenya , Nairobi , East Africa

Date Posted: Thursday, March 09, 2023 , Base Salary: Not Disclosed

Similar Jobs in Kenya
Learn more about Britam
Britam jobs in Kenya


Job Purpose:
Controlling and Managing policies through case management to ensure quality and cost effective care, client service, processing and payment of EMC claims.

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.
• 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:

• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least one-year experience in case management and claims processing.

Technical/ Functional competencies:
• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.

Leadership category responsibility framework (Core Competencies):

Emerging Leaders in Britam need to:
• Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost and team targets.
• Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation.
• Ensure that department priorities are adhered to and effectively communicated.
• Ensure competent and effective people resources through appropriate coaching, development and people supervision as appropriate.
• Embody a high performance, proactive culture.
• Effectively ensure the adherence to key performance areas, deadlines and goals in order to optimize operational effectiveness.
• Effectively communicate resource needs, possible opportunities and achievements to management in order to aid them in their decision-making.
• Effectively set and monitor priorities and objectives for more junior staff.
• Understand and communicate objectives in relation to the larger organizational impact.
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
• Appropriately model the company values while setting the pace and energy for delivering.
• Effectively manage and communicate change within the department in order to increase staff and process effectiveness.
• Provide access to accurate and consistent information and services across all channels.
• Ensure a seamless experience for clients.
• Improve service delivery for clients.
• Engage in continuous brand building to become the trusted partners to clients.

Work Hours: 8

Experience in Months: 12

Level of Education:
Professional Certificate

Job application procedure

Interested and qualified? Click Here to Apply

All Jobs


Job Info
Job Category: Accounting/ Finance jobs in Kenya
Job Type: Full-time
Deadline of this Job: 24 March 2023
Duty Station: Nairobi
Posted: 10-03-2023
No of Jobs: 1
Start Publishing: 09-03-2023
Stop Publishing (Put date of 2030): 09-03-2067
Apply Now

Notification Board:

Join a Focused Community on job search to uncover both advertised and non-advertised jobs that you may not be aware of. A jobs WhatsApp Group Community can ensure that you know the opportunities happening around you and a jobs Facebook Group Community provides an opportunity to discuss with employers who need to fill urgent position. Click the links to join. You can view previously sent Email Alerts here incase you missed them and Subscribe so that you never miss out.

Caution: Never Pay Money in a Recruitment Process.

Some smart scams can trick you into paying for Psychometric Tests.