We are seeking a highly motivated professional to oversee and execute a range of critical duties, including managing daily operations, ensuring compliance with industry standards, and collaborating with cross-functional teams to drive project success. The ideal candidate will possess strong analytical skills, exceptional communication abilities, and prior experience in a similar role, with a proven track record of delivering measurable results. Responsibilities encompass strategic planning, process optimization, stakeholder engagement, and performance monitoring to enhance productivity and achieve organizational objectives. Proficiency in relevant software tools and a commitment to continuous improvement are essential requirements for this position.
Care Management involves overseeing Outpatient, Optical, and Dental preauthorizations while ensuring prompt communication with providers, clients, and brokers regarding any actions taken, rejections, or pertinent concerns. Additionally, the role includes managing the 24-hour emergency line to address urgent matters efficiently.
Oversee and execute a broad spectrum of critical duties, including the development and implementation of strategic initiatives to enhance operational efficiency and drive organizational growth. Serve as a key liaison between senior leadership and departmental teams, ensuring seamless communication and alignment of objectives. Lead cross-functional projects, fostering collaboration and accountability among stakeholders to achieve measurable outcomes. Analyze performance metrics and market trends to identify opportunities for innovation and continuous improvement. Mentor and guide team members, cultivating a high-performance culture through coaching and professional development. Ensure compliance with industry regulations and internal policies while maintaining a strong focus on risk management and quality assurance.
Care Management involves conducting thorough due diligence to ensure that all undertakings align precisely with the stipulated policy provisions. Similarly, for declined applications, the role demands meticulous attention to detail to guarantee that decisions are not only accurate but also reflect a correct interpretation of the policy.
Ensure strict compliance with established turnaround times for the issuance of approvals.
We require comprehensive medical clarifications, which include obtaining medical reports and copies of investigation reports from healthcare providers, following established standard procedures.
We ensure seamless broker/customer relations by promptly conveying all essential claim decisions to clients.
Collaborate closely with the claims team to furnish any necessary information regarding claims submissions, ensuring that any additional details provided may result in a reassessment of the previously determined claim position.
Engaging with clients, brokers, and providers as required, the incumbent resolves issues in compliance with legal, ethical, and policy-driven standards to ensure alignment with organizational principles.
Facilitating discussions with providers to address cost-related matters, including negotiating discounts, pre-established rates, bundled packages, fixed-cost arrangements, and average-cost agreements.
Ensure the system reflects precise data and achieves flawless benefit adjudication across all cases, maintaining a zero-error rate.
Collaborate with the underwriting department to define the parameters of coverage for multiple schemes.
The incumbent will collaborate with the provider relations department to address matters concerning the provider panel, as well as customer complaints.
Overseeing the round-the-clock emergency helpline operation, ensuring seamless coordination and response to critical inquiries.
Strategic initiatives will be executed for the department, guided by recommendations from the Claims Quality Assurance Committee.
Ensure all customer service indicators consistently achieve the Net Promoter Score (NPS) benchmark.
Ensure strict adherence to internal business processes, IRA regulations, and established ethical standards within the department to maintain full compliance with all applicable guidelines and requirements.
Client presentations will be conducted to effectively communicate key insights on optimal resource allocation and risk mitigation strategies, ensuring informed decision-making. Additionally, responsibilities include delivering comprehensive member education programs designed to enhance understanding of prudent utilization practices and robust risk management frameworks.
The care management team receives support to ensure all deliverables are completed within the specified timeframe.
Proven expertise in [specific skills] and the ability to demonstrate [relevant competencies] are essential for success in this role. Candidates must exhibit strong [key skill, e.g., analytical thinking] along with proficiency in [specific tool, methodology, or area, e.g., data analysis or project management]. Additionally, exceptional [soft skill, e.g., communication] and [another soft skill, e.g., problem-solving] are critical for collaborating effectively with teams and stakeholders. Familiarity with [industry-specific or technical requirement] and adherence to [standard or best practice] are also required. The ideal candidate will possess a combination of technical acumen and interpersonal strengths to drive [specific outcome or goal].
Develops, implements, and oversees the administration of comprehensive health benefits plans, ensuring alignment with organizational objectives and compliance with regulatory standards. Collaborates with cross-functional teams, including HR, finance, and legal departments, to design competitive and sustainable benefits packages. Analyzes utilization data and market trends to optimize plant performance, cost efficiency, and employee satisfaction. Manages vendor relationships, negotiates contracts, and monitors service delivery to maintain high-quality benefits administration. Ensures timely enrollment, accurate record-keeping, and clear communication of benefits policies to employees. Provides expert guidance on benefits-related inquiries and resolves complex issues to support workforce well-being.
Interprets and clarifies organizational policies, ensuring alignment with regulatory standards and best practices, while providing guidance to stakeholders on their application and implications.
Dedicated to delivering exceptional service, this role emphasizes a strong customer-centric approach, ensuring every interaction meets or exceeds expectations. The ideal candidate will prioritize responsiveness, problem-solving, and clear communication to foster positive customer experiences. Key responsibilities include addressing inquiries, resolving issues promptly, and maintaining a thorough understanding of products or services to provide accurate assistance. Proficiency in communication tools and a commitment to maintaining a professional demeanor under pressure are essential. This position requires adaptability, patience, and a genuine passion for supporting customers to drive satisfaction and loyalty.
We require a dedicated professional who demonstrates unwavering responsibility and a strong commitment to their role and organization. The ideal candidate must be highly reliable, consistently meeting deadlines and maintaining high standards of quality in their work. They should exhibit a proactive approach, taking ownership of tasks and ensuring thorough follow-through. Additionally, they must align with the company’s values and contribute to a positive, collaborative work environment.
We thrive in an environment that values collaboration and collective success, where each team member’s contributions are essential to our achievements. To excel in this role, you must be adept at working in cross-functional teams, possess strong interpersonal skills, and demonstrate a commitment to shared goals and mutual support. Your ability to communicate effectively, adapt to team dynamics, and foster a positive work culture will be key to driving our success. We seek individuals who not only perform their responsibilities with excellence but also uplift their colleagues and contribute to a cohesive, high-performing team.
Excellent interpersonal and written communication skills are essential, with the ability to convey complex ideas clearly and concisely. Candidates must demonstrate strong verbal articulation and active listening to engage effectively with stakeholders at all levels. Proficiency in crafting professional emails, reports, and presentations is required to support collaborative efforts and decision-making processes.
Demonstrates strong organizational skills and the capacity to handle multiple responsibilities simultaneously.
Exceptional proficiency in negotiation and sound decision-making abilities are essential for this role.
Seeking a candidate with a strong foundation in relevant industry expertise and substantial professional background. Ideal applicants must possess a minimum of five years of hands-on experience in a comparable role, along with a proven track record of delivering measurable results. Proficiency in key technical and operational competencies is essential, as is the ability to adapt to evolving business demands. The position requires a deep understanding of industry best practices and the capacity to apply that knowledge effectively in dynamic work environments.
A minimum of two years of professional experience in case management or a closely related field is required.
Experienced in overseeing patient admissions and discharges, ensuring efficient and accurate management of these critical processes.
Academic and Professional Qualifications Required
Applicants must possess the necessary academic credentials and professional experience to fulfill the position’s requirements. A relevant degree from an accredited institution is essential, complemented by a minimum number of years of professional experience in the field. Additionally, candidates should meet any specialized certifications or license standards pertinent to the role. Proficiency in relevant technical skills or methodologies may also be required, depending on the position’s demands.
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, with a deadline of Wednesday, 17th June 2026.
Qualifications
BA/BSc/HND
Experience Required
2 years
