Case Management Officer Job Britam
Insurance Jobs, Britam Jobs.
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.
- Perform any other duties as may be assigned from time to time.
Knowledge, experience and qualifications required
- Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
- At least 2 -4 years experience in case management and claims processing.
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.
How to Apply
🎯 Before You Apply For this Job.
This job will attract 1000+ applicants.
Many qualified professionals will miss out on getting shortlisted and interviews — not because they lack experience, but because their CV doesn’t clearly show how they fit this specific job.
🎯 Want to get an interview fast? Customize your CV specifically for this job.
Using the same CV for every application will not get you interviews.
Contact Rose our client service manager and together with our recruiters she will review your CV and show you exactly how to improve it for the job you are targeting. Click Here For Us To Customize Your CV For This Job Opportunity
Is your AI CV not getting you interviews? Click Here To Get A Professionally Written CV
Read Job Seeker Testimonials Below: Professionals Who Got Jobs Through Corporate Staffing
Related Jobs To Check Out
Jobs Managed by Our Recruitment Team
The vacancies below are managed directly by the Corporate Staffing recruitment team on behalf of our clients. Review the job advert, then submit your application through our recruitment team for consideration.
Browse Other Jobs Posted Today
Explore the latest job opportunities posted now. Apply early to maximize your chances, as many employers begin reviewing applications as soon as suitable candidates apply.