Primary responsibilities include overseeing key operational tasks, ensuring alignment with organizational objectives, and fostering an environment of efficiency and accountability. Responsibilities also encompass coordinating cross-functional teams, implementing strategic initiatives, and maintaining compliance with industry regulations. Additionally, the role involves analyzing performance metrics, identifying areas for improvement, and driving continuous enhancement across processes.
Experienced professionals in Care Management are responsible for overseeing Outpatient, Optical, and Dental preauthorizations, ensuring seamless coordination with providers, clients, and brokers. This role involves timely communication regarding pending tasks, rejections, or critical concerns, as well as overseeing the 24-hour emergency line to address urgent matters promptly.
Oversee and execute critical responsibilities to drive organizational success, including managing key projects, analyzing performance metrics, and maintaining compliance with industry standards. Coordinate cross-functional teams to streamline processes, identify growth opportunities, and implement innovative solutions. Ensure accurate reporting and documentation while fostering collaboration among departments to achieve strategic objectives. Develop and monitor budgets, track expenditures, and optimize resource allocation to maximize efficiency.
Care Management – Conducting thorough due diligence to issue undertakings in strict alignment with policy provisions, while also ensuring that decline decisions are both accurate and reflective of precise policy interpretation.
Maintain strict adherence to established Turnaround Times when issuing approvals to ensure timely processing.
We require the acquisition of medical clarifications, including medical reports and copies of investigation reports from healthcare providers, in accordance with established protocols.
Broker/customer relations involve conveying all essential claim decisions to clients promptly and effectively.
Collaborate closely with the claims team to furnish any necessary details regarding claims submitted, ensuring that any additional information provided alters the previously established position on the claim.
Engaging with clients, brokers, and providers as required, the role involves addressing challenges in compliance with legal, ethical, and policy-driven standards to ensure resolution.
Engaging providers to discuss cost-related matters, including discounts, pre-arranged rates, bundled packages, fixed-cost arrangements, and average cost agreements.
Guarantee the precise recording of details within the system while maintaining an impeccable track record in benefit adjudication for every case processed.
Serving as a liaison between our organization and the underwriting department, you will collaborate closely to define and refine the scope of coverage for a diverse range of insurance schemes. This role requires active engagement in discussions to ensure alignment between underwriting policies and the specific needs of each program.
The position involves collaborating with the provider relations department to address issues related to the provider panel, customer complaints, and other pertinent matters.
Overseeing a round-the-clock emergency helpline, ensuring seamless operation and prompt response to critical inquiries.
Strategic initiatives within the department will be executed, alongside recommendations provided by the Claims Quality Assurance Committee.
Strive to attain a Net Promoter Score (NPS) benchmark across all customer service metrics.
Ensure strict observance of all internal business processes, IRA regulations, and departmental guidelines while maintaining the highest standards of professional ethics and integrity at all times.
Client presentations and member education initiatives are designed to promote prudent utilization practices and enhance risk management awareness. This role involves delivering engaging, informative sessions to clients and members, highlighting best practices for optimal use and strategies to mitigate potential risks.
Collaborate closely with the care management team to guarantee that all deliverables are completed within the specified turnaround time.
A strong candidate will possess a comprehensive set of skills and competencies, including [list any specific skills, e.g., technical expertise in X, proficiency in Y software, analytical abilities, etc.]. The ideal applicant must demonstrate exceptional [mention key competencies, e.g., problem-solving skills, attention to detail, leadership qualities, etc.]. Additionally, they should exhibit strong [mention another competency, e.g., communication skills, time management capabilities, adaptability, etc.] to thrive in a fast-paced environment. Prior experience in [relevant field or task] is essential, along with the ability to [mention a key responsibility or requirement]. The role demands a proactive approach, ensuring [describe a key outcome or responsibility] while maintaining high standards of [mention a relevant quality, e.g., accuracy, efficiency, customer service].
The position involves overseeing the administration and strategic oversight of health benefits plans, ensuring alignment with organizational objectives and regulatory standards. Responsibilities include evaluating plan options, negotiating with providers, and managing enrollment processes to optimize coverage and cost efficiency. Additionally, the role requires monitoring plan performance, analyzing utilization trends, and recommending modifications to enhance employee satisfaction and financial sustainability. Strong analytical skills, proficiency in benefits administration software, and a deep understanding of compliance requirements are essential. Experience in health benefits plan design and vendor management is preferred.
Interprets and clarifies organizational policies, ensuring employees understand their implications and application. Analyzes policy documents to resolve ambiguities and provide accurate guidance. Serves as a resource for staff inquiries regarding policy adherence, exceptions, or modifications. Collaborates with department heads to align policies with operational needs and regulatory standards. Documents interpretations and updates stakeholders on policy changes or clarifications.
Delivering exceptional customer service requires a client-centric approach, ensuring each interaction is handled with professionalism, empathy, and efficiency. The role demands strong communication skills, both verbal and written, to address inquiries, resolve issues, and maintain high levels of customer satisfaction. Candidates must demonstrate problem-solving abilities, patience, and a proactive mindset to anticipate and meet customer needs effectively. Experience in handling customer inquiries, whether through phone, email, or in-person, is preferred, along with the capacity to work in fast-paced environments while maintaining composure and a positive attitude.
The role demands a high level of dedication and accountability, requiring a steadfast adherence to assigned tasks and deadlines. It involves maintaining consistent performance standards while ensuring alignment with organizational objectives. Full-time engagement is expected, with the ability to manage multiple responsibilities efficiently and adapt to evolving priorities. Candidates must demonstrate reliability, professionalism, and the capacity to uphold commitments under varying conditions.
We are seeking a dynamic individual who thrives in collaborative environments and champions collective success. The ideal candidate will demonstrate a strong commitment to fostering teamwork, driving engagement, and ensuring that every team member feels valued and motivated. Key responsibilities include organizing team-building activities, facilitating open communication, and resolving conflicts to maintain a harmonious and productive workplace. The role requires exceptional interpersonal skills, emotional intelligence, and the ability to inspire and unite diverse groups toward shared goals. A proven track record in team leadership, conflict resolution, and creating an inclusive culture is essential. Experience in designing and implementing team development programs will be a significant advantage.
Excellent interpersonal and written communication skills are essential for collaborating effectively with colleagues, clients, and stakeholders. The ability to convey complex information clearly and concisely is crucial for this role. Additionally, active listening and professional correspondence are required to ensure smooth interactions and foster productive relationships.
Demonstrated capacity to manage multiple tasks concurrently while maintaining high levels of organization and efficiency.
Exceptional aptitude for negotiation and decisive judgment are essential.
We seek candidates with a solid academic foundation and relevant professional experience in the specified field. A minimum of [X] years of hands-on experience in a comparable role is required, along with expertise in [specific skills, tools, or methodologies]. Familiarity with industry best practices and the ability to apply theoretical knowledge to practical scenarios are essential. Additionally, prior experience in [specific industry, sector, or type of organization] is highly advantageous.
A minimum of two years of professional experience in case management or a closely related field is required.
Requires proven expertise in overseeing patient admissions and discharges, ensuring accurate documentation and smooth transitions throughout the care process.
Required qualifications include a relevant academic degree and professional certifications, along with demonstrated experience in the field. Candidates must hold a minimum of a bachelor’s degree in a related discipline, such as education, counseling, or social work, and possess applicable certifications aligned with the role’s demands. Additionally, applicants should showcase a proven track record of at least two years of hands-on experience in a professional setting, with a strong emphasis on expertise in program development, implementation, and evaluation.
A bachelor’s degree in nursing or a related field in clinical medicine is required for this position.
Applications must be submitted to the Group Human Resources Manager at Madison Group Limited by emailing hr_recruitment@madison.co.ke, ensuring receipt no later than Wednesday, June 17th, 2026.
Qualifications
BA/BSc/HND
Experience Required
2 years
