Case Management Officer

About the role

The Case Management Officer will oversee the end‑to‑end processing of Britam Microinsurance claims, ensuring that members receive timely, quality care while controlling costs. You will act as the bridge between clients, service providers, and underwriters, guaranteeing compliance with policy guidelines.

Key responsibilities

• Set claim parameters such as reserve, authorized cost and duration for each admission.
• Interact with clients and providers to confirm care aligns with policy rules.
• Review medical reports and claims for compliance and audit both outpatient and inpatient submissions.
• Liaise with underwriters to clarify scope of cover for various schemes.
• Provide 24‑hour support through the call centre and ensure round‑the‑clock assistance for scheme members.
• Discourage poly‑pharmacy and promote generic substitution to reduce pharmaceutical spend.
• Verify completeness of claim documentation and maintain accurate claims registers.
• Respond to internal and external inquiries regarding claims processes and required forms.
• Prepare reports for claims meetings and follow up on pending documents.

Required profile

• Professional Nursing qualification (KRCHN) licensed by the Nursing Council of Kenya.
• 2–4 years of experience in case management and claims processing.
• Good knowledge of insurance regulatory requirements and insurance products.

Required skills

What we offer

• Permanent full‑time position with day‑shift schedule.
• Opportunity to work in a dynamic micro‑insurance environment.
• Professional development and exposure to both clinical and insurance domains.