Oversee and execute key duties that encompass the core functions of the role, ensuring alignment with organizational objectives and operational standards. Lead critical projects from inception to completion, maintaining a focus on efficiency, quality, and adherence to deadlines. Collaborate closely with cross-functional teams to streamline processes, enhance productivity, and drive measurable outcomes. Serve as a primary point of contact for stakeholders, providing clear communication and strategic guidance to facilitate informed decision-making. Monitor performance metrics to identify areas for improvement, implementing corrective actions as needed to optimize workflows and achieve desired results. Maintain a thorough understanding of industry trends and best practices to continuously refine approaches and sustain competitive advantage.
Care Management involves overseeing preauthorization processes for Outpatient, Optical, and Dental services, while coordinating with providers, clients, and brokers to address undertakings, rejections, or other pertinent matters in a timely manner. Additionally, responsibilities include managing the 24-hour emergency line.
Oversee a range of critical duties including strategic planning, team leadership, and project execution to ensure organizational objectives are met. Collaborate with cross-functional departments to streamline processes, enhance productivity, and drive sustainable growth. Monitor performance metrics, identify areas for improvement, and implement data-driven solutions to optimize operational efficiency. Supervise staff development, foster a culture of accountability, and ensure compliance with company policies and industry regulations. Serve as a liaison between senior management and employees, facilitating clear communication and aligning team efforts with broader business goals.
Through meticulous due diligence, the role involves issuing undertakings strictly in accordance with policy provisions. Additionally, for declined applications, the incumbent must verify that decisions are both precise and reflect an accurate interpretation of the policy guidelines.
Maintain adherence to established Turnaround Time benchmarks when issuing approvals.
Medical clarifications are required, including obtaining medical reports and copies of investigation reports from healthcare providers in accordance with established procedures.
Maintaining strong broker/customer relationships by promptly conveying all essential claim decisions to clients is a key responsibility.
Collaborate closely with the claims team to furnish any necessary details regarding claims submitted, especially when supplementary information alters the stance previously adopted on the claim.
Interacting with clients, brokers, and providers as required, you will address issues in compliance with legal standards, ethical guidelines, and company policy principles.
Negotiating with providers regarding cost structures, including discounts, pre-established rates, bundled packages, fixed pricing, and average cost arrangements.
Maintain flawless precision in benefit adjudication, guaranteeing that all cases are processed with absolute accuracy and zero errors while ensuring system records reflect the most reliable information available.
Serves as the primary point of contact between the underwriting department and other teams to discuss and define the scope of coverage for diverse insurance schemes.
Liaising with the Provider Relations team to address issues related to the provider network, customer complaints, and other pertinent matters is a key responsibility.
Overseeing the round-the-clock emergency helpline operations, ensuring seamless responsiveness and coordination to address urgent inquiries and critical situations effectively.
Implementation of strategic initiatives recommended by the Claims Quality Assurance Committee is a key responsibility of this role.
We aim to attain a Net Promoter Score (NPS) target across all customer service metrics.
To ensure adherence to internal business processes, IRA regulations and guidelines, as well as maintaining ethical standards within the department, compliance is essential. Upholding these principles is critical to the effective operation and integrity of the department.
Responsibilities include delivering client presentations and conducting member education sessions focused on prudent use and risk mitigation strategies.
Collaborate closely with the care management team to guarantee that all deliverables are completed promptly and within the specified timeframe.
Proven expertise in a relevant field, along with strong interpersonal and communication abilities, is essential. The ideal candidate will demonstrate proficiency in critical thinking, problem-solving, and adaptability to evolving challenges. Previous experience in a similar role, coupled with a commitment to continuous learning, is highly valued. Attention to detail, organizational skills, and the capacity to collaborate effectively within a team are also required. Familiarity with industry-specific tools, methodologies, and best practices is mandatory.
Oversee the strategic administration and operational execution of the company’s health benefits program, ensuring alignment with organizational objectives and regulatory standards. Develop, implement, and maintain policies and procedures that optimize coverage, cost efficiency, and employee satisfaction. Manage vendor relationships to negotiate competitive rates, enhance service quality, and resolve disputes promptly. Analyze utilization trends, claim data, and performance metrics to identify opportunities for program enhancements and cost savings. Provide expert guidance to leadership and employees on benefit options, eligibility, and compliance requirements. Collaborate with HR, finance, and legal teams to streamline processes and ensure seamless integration with broader compensation and benefits frameworks.
Policy interpretation involves analyzing and clarifying complex regulations to ensure accurate application in organizational contexts. This role requires a deep understanding of legal frameworks, compliance standards, and industry-specific guidelines to address ambiguities and provide actionable guidance. Professionals in this position must assess policies against operational needs, identify potential risks, and recommend modifications to align with evolving requirements. Strong analytical skills, attention to detail, and the ability to communicate intricate concepts clearly are essential. Experience with regulatory frameworks and a background in law, public administration, or a related field is typically required.
Dedicated to delivering exceptional customer experiences, we seek a professional committed to providing outstanding service and maintaining a strong customer focus. The ideal candidate will prioritize client satisfaction, address inquiries promptly, and resolve issues with efficiency and empathy. Strong interpersonal skills and a proactive approach are essential to ensure seamless interactions and build lasting customer relationships.
We are seeking a dedicated professional to uphold the highest standards of responsibility and commitment in this role. The ideal candidate will demonstrate unwavering dedication to fulfilling all assigned tasks with precision and timeliness. Strong accountability for meeting deadlines and maintaining consistent performance is essential, as is the ability to prioritize responsibilities effectively under varying circumstances. A proactive approach to problem-solving and a consistent focus on delivering high-quality results are paramount to success in this position.
We foster a collaborative environment where employees work together effectively, leveraging each other’s strengths to achieve shared objectives. Our ideal candidate demonstrates strong interpersonal skills, adaptability, and a commitment to mutual support within the team. We seek individuals who actively contribute to a positive workplace culture, encourage open communication, and embrace diverse perspectives to enhance team performance.
Excellent interpersonal skills are essential, with a demonstrated ability to convey ideas clearly and persuasively. Strong written and verbal communication is required to interact effectively with stakeholders at all levels. The role demands active listening to understand diverse perspectives and the capacity to articulate complex information in an accessible manner.
Demonstrates exceptional skill in managing multiple tasks simultaneously while maintaining high standards of efficiency and accuracy. Exhibits strong organizational abilities to prioritize competing demands and adapt to shifting priorities in a fast-paced environment. Proven capability to handle diverse responsibilities without compromising quality or timeliness of deliverables.
Exceptional proficiency in negotiation and decisive judgment is required.
Seeking a candidate with substantial expertise and hands-on experience in the relevant field. The ideal applicant will possess a comprehensive understanding of key concepts and practical skills honed through relevant professional roles. Proven track record in applying knowledge effectively to drive results and solve complex challenges is essential.
A minimum of two years of hands-on experience in case management or a related field is required.
Proven expertise in overseeing the entire process of patient admissions and discharges within a healthcare setting.
Academic and professional credentials necessary for consideration include a relevant degree from an accredited institution, along with specialized certifications or licenses pertinent to the field. Candidates must also demonstrate a proven track record of professional experience in a similar role, supported by verifiable references or performance evaluations. Additionally, any required industry-specific qualifications, such as advanced technical skills, certifications, or compliance training, must be met to ensure eligibility for the position.
A bachelor’s degree in nursing or a clinical medical discipline is required.
Applications must be submitted to the Group Human Resources Manager at Madison Group Limited via email at hr_recruitment@madison.co.ke, ensuring receipt no later than Wednesday, 17th June 2026.
Qualifications
BA/BSc/HND
Experience Required
2 years
