Senior Case Management Officer at Britam

Job Description

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, Banking and Property. Our Mission is to provide outstanding financial services to our customers. Our Vision is to be the most trusted financial service partner. We aim to provide our clients, with an unmatched offering, ensuring first class solutions that help secure the future.

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.

Key Performance Measures:

As described in your Personal Scorecard.

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.

Leadership category responsibility framework (Core Competencies):
Team Leaders in Britam need to:

Operationally lead a team to service customers from a sustainable and growing customer base whilst increasing profit. Ensure the company’s objectives are met by being a vision carrier and by implementing strategy and operational outputs. Effectively run the business and manage staff in order to enable functional leaders to focus on developing strategy. Effectively identify and define key performance areas, deadlines and goals for their team in order to optimise operational effectiveness. Ensure the department has the most appropriate people capability through effective inspirational leadership, people development, effective selection and optimised succession planning. Create a high performance, proactive culture and motivated team. Monitor operational implementation, budgets, plans, goals and outputs in order to ensure alignment with the departmental strategy. Ensure that department priorities are adhered to and effectively communicated. Effectively disseminate knowledge within the correct context, towards subordinates as well as management. Appropriately model the company values while setting the pace and energy for delivering. Benchmark operational activities internally as well as externally in order to be a leader in the industry. Effectively manage and communicate change within the department in order to increase staff and process effectiveness. Provide access to accurate and consistent information and services across all channels. Adequately manage operational risk.