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Senior Case Management Officer– Wellness & Provider Relations
Britam
Nairobi, KE
Full-time
Posted 3 weeks ago
Job Description
• Job Purpose: Supervising Health Care processes and procedures through the use of effective techniques to achieve the objectives of cost, Quality control and operational efficiency. 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.
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.
• 6-8 years’ experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.
• Knowledge of insurance concepts.
• Technical/ Functional competencies.
• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.
Primary Location
Kenya-Nairobi-Nairobi
Organization
Britam
Job Type
Permanent
Shift
Day Job
Contract Type
Full-time
Job Posting
11-03-2026
Unposting Date
Ongoing
Number of Openings
1
• 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, 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.
• 6-8 years’ experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.
• Knowledge of insurance concepts.
• Technical/ Functional competencies.
• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.
Primary Location
Kenya-Nairobi-Nairobi
Organization
Britam
Job Type
Permanent
Shift
Day Job
Contract Type
Full-time
Job Posting
11-03-2026
Unposting Date
Ongoing
Number of Openings
1
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