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...

Responsibilities or duties

Key responsibilities:

• Ensure quality & affordable care to all admitted patients.
• Analysis and interpretation of admission, savings and average cost reports for effective cost control.
• Enrolment of members to CDM program and follow up.
• Work with the wellness team to ensure compliance.
• Verification and audit of outpatient and inpatient approval requests as per the claims manual and customer service charter manual to ensure compliance and mitigate risk
• Supervise; train and mentor case management officers to achieve a high level of motivation and productivity by the team.
• Negotiate professional fees and hospital charges including discounts to control expenditure.
• Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
• Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
• Prepare regular care reports to clients, management and advice medical underwriting section on relevant care findings for medical risk review.
• Delegated Authority: As per the approved Delegated Authority Matrix.
• Perform any other duties as may be assigned from time to time.

Qualifications or requirements (e.g., education, skills)

Knowledge, experience and qualifications required:

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Professional qualification in Insurance (ACII, FLMI or IIK) – added advantage.
• Knowledge of insurance concepts.
• Technical/ Functional competencies.
• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.

Experience needed

6-8 years’ experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.

• Ensure quality & affordable care to all admitted patients.
• Analysis and interpretation of admission, savings and average cost reports for effective cost control.
• Enrolment of members to CDM program and follow up.
• Work with the wellness team to ensure compliance.
• Verification and audit of outpatient and inpatient approval requests as per the claims manual and customer service charter manual to ensure compliance and mitigate risk
• Supervise; train and mentor case management officers to achieve a high level of motivation and productivity by the team.
• Negotiate professional fees and hospital charges including discounts to control expenditure.
• Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
• Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
• Prepare regular care reports to clients, management and advice medical underwriting section on relevant care findings for medical risk review.
• Delegated Authority: As per the approved Delegated Authority Matrix.
• Perform any other duties as may be assigned from time to time.

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

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Professional qualification in Insurance (ACII, FLMI or IIK) – added advantage.