Case Management Officer – Hospital Claims & Clinical Coordination

About the role

The Aga Khan Hospital in Kisumu is seeking a Case Management Officer to bridge clinical care and financial operations. Reporting to the Assistant Claims Manager, you will oversee patient care plans, ensure accurate medical claim processing, and act as the primary liaison between clinicians, insurers, and billing teams.

Key responsibilities

• Monitor active patient care, track length of stay, and verify clinical necessity in real time.
• Secure pre‑authorizations and manage scheme limits to prevent charge accumulation.
• Audit treatment patterns, flag over‑utilisation, and ensure adherence to clinical protocols.
• Validate and code all claims using ICD‑10 before dispatch to corporate clients.
• Liaise with attending physicians, insurance case managers, and internal billing staff to resolve clinical queries and clear discharge documentation.

Required profile

• Experience in hospital case management, medical billing, or health‑insurance coordination.
• Strong understanding of clinical workflows and financial policies.
• Excellent attention to detail and ability to work under tight deadlines.

Required skills

• ICD‑10 coding
• Claims auditing
• Utilisation review
• Medical billing processes
• Health‑insurance scheme navigation