Assistant Director, Claims Management Job SHA

Insurance Jobs, The Social Health Authority Jobs.

Qualifications, Skills and Experience Required:

Promotional – Claims Management (Medical Review): 

• Cumulative service period of twelve (12) years relevant work experience, three (3) of which should have been at the grade of Principal Claims Management Officer or a comparable position.
• Bachelor’s Degree in Medicine and Surgery from a recognized institution.
• Master’s Degree in Medicine and Surgery from a recognized institution.
• A valid practicing license from a recognized institution.
• Certificate in Leadership course lasting not less than four (4) weeks from a recognized institution.
• Proficiency in computer applications.
• Demonstrated managerial, administrative, and professional competence in work performance and results.

Responsibilities:

• Coordinating medical reviews and interpretation of medical reports.
• Coordinating the reviewing, processing, and validating of medical claims from healthcare providers and facilities for accuracy and adherence to policies.
• Coordinating the appraisal of medical claims based on the benefit package to ensure fair and timely disbursement of funds.
• Ensuring issuance of pre-authorizations for access to healthcare services.
• Maintaining and operationalizing an e-claims and case management system.
• Ensuring sensitization of claimants on the consequences of submitting false and fraudulent claims.
• Coordinating the collection and analysis of data for claim management to inform strategic decisions.
• Preparing quarterly reports on claims for submission to the Board and Cabinet Secretary.
• Carrying out any other necessary functions for the Authority’s mandate.
• Coordinating the management of contracted and outsourced claims management services.
• Coordinating quality assurance surveillance to identify gaps and recommend corrective actions.

How to Apply

To access the full advertisement, including detailed job descriptions, core functions, and person specifications, kindly visit the SHA website at https://recruitment.sha.go.ke/

Application Requirements

Applicants must satisfy the requirements of Chapter Six of the Constitution of Kenya by submitting valid and current copies of the following:

• Certificate of Good Conduct from the Directorate of Criminal Investigations.
• Tax Compliance Certificate from the Kenya Revenue Authority (KRA).
• Clearance Certificate from the Higher Education Loans Board (HELB).
• Clearance Certificate from the Ethics and Anti-Corruption Commission (EACC).
• Report from a Credit Reference Bureau (CRB).

How to Apply

Interested candidates should submit their applications, including:

• A detailed curriculum vitae (CV).
• Copies of academic and professional certificates.
• A cover letter demonstrating suitability for the position.
• Contacts of at least three professional referees.

Applications should be addressed to: The Chairperson Social Health Authority P. O Box 30443-00100 Ragati Road NAIROBI

Applications can be submitted online on https://recruitment.sha.go.ke/ or physically delivered to the SHA building 10th floor by clearly marking the position applied for on the envelope.

Deadline

All applications must be received by 5.00 pm 18th November, 2025.

Terms of Service

A competitive remuneration package as advised by the Salaries & Remuneration Commission will be offered to the successful candidate.