Deputy Director, Claims Management Job SHA

Deputy Director, Claims Management Job SHA

Minimum Qualifications:Masters Degree

Job Term: Permanent and Pensionable

Position Level: SHA 3

Remuneration:

Basic Salary: Kes.243,348 x 12,172 – 255,521 x 12,775 – 268,295 x 13,418 – 281,714 x 14,085 – 295,799 x 14,787 – 310,586 x 15,530 – 326,116 x 16,308 – 342,423 x 17,115 – 359,538 x 17,987 – 377,525 x 18,870 – 396,395 x 19,817 – 416,212 pa.
House Allowance: Kes 65,000/=, Commuter Allowance: Kes 26,000/=, Entertainment Allowance: Kes 12,500/=

Number of positions:1

Qualifications, Skills and Experience Required:

• Fifteen (15) years of cumulative service period of work experience, with at least three (3) years at Assistant Director, Claims Management Officer or comparable.
• Bachelor’s Degree in Medicine and Surgery from a recognized institution (for Medical Review). 
• Master’s Degree in Medicine and Surgery from a recognized institution (for Medical Review).
• 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:

Job Purpose: 

This cadre is responsible for ensuring that claims are processed and cases are managed efficiently and effectively.

Functions: 

• Coordinating medical reviews and interpretation of medical reports.
• Overseeing the reviewing, processing, and validating of medical claims from healthcare providers and healthcare facilities to ensure accuracy and adherence to policies.
• Coordinating the appraisal of medical claims based on the benefit package to ensure fair and timely disbursement of funds.
• Overseeing the issuance of pre-authorizations for access to healthcare services based on the benefit package while ensuring efficiency in service delivery.
• Ensuring assessment of quality health care providers for purposes of declaration.
• Ensuring enforcement and compliance with contractual provisions by healthcare providers.
• Spearheading the development and operationalization of an e-claims management system for improved claims processing and fraud detection.
• Coordinating the undertaking of quality assurance surveillance in respect of claims to identify gaps and recommend corrective actions.
• Establishing systems and controls for detecting and identifying fraud appropriate to the Authority’s exposure and vulnerability to minimize financial risks.
• Facilitating sensitization of claimants on the consequences of submitting false and fraudulent claims to enhance compliance and transparency.
• Coordinating the collection and analysis of data for purposes of claim management to inform strategic decisions and policy formulation.
• Supervising the preparation of quarterly reports on claims for submission to the Board and the Cabinet Secretary to ensure timely reporting and accountability.
• Carrying out any other functions as necessary for the better execution of the Authority’s mandate under the Act.
• Coordinating the management of contracted and outsourced claims management services to enhance efficiency and service delivery.

How to Apply

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

How to submit online applications

• Create an account
• Complete your profile by filling in your details in all the relevant sections
• Click on the vacancies tab
• On the jobs list, click on View Details to access the details of a particular job
• At the bottom section of the job’s detail, click on Apply to submit your application

Physical applications should be addressed to:

The Chairperson
Social Health Authority
P. O Box 30443-00100
Ragati Road
NAIROBI

Interested candidates should submit their applications, including:

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

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.
• 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).

Apply by 19th August, 2025 by 5.00P.M