Oversee and execute key responsibilities central to the role, ensuring alignment with organizational objectives. Execute tasks that drive operational efficiency and contribute to the achievement of departmental goals. Collaborate with cross-functional teams to implement initiatives that enhance productivity and streamline workflows. Monitor performance metrics to assess progress and identify opportunities for improvement. Maintain compliance with industry regulations and internal policies to uphold standards of excellence. Serve as a liaison between leadership and staff to facilitate clear communication and foster a cohesive work environment.
Care Management involves processing preauthorizations for Outpatient, Optical, and Dental services while ensuring seamless communication with providers, clients, and brokers regarding undertakings, rejections, or any pertinent issues. Additionally, this role is responsible for overseeing the 24-hour emergency line to address urgent inquiries and concerns promptly.
Oversee a range of essential duties, including but not limited to strategic planning, team leadership, and cross-departmental collaboration, to ensure organizational objectives are met with precision and efficiency. Develop and implement policies and procedures that enhance operational workflows while maintaining compliance with industry regulations and company standards. Monitor performance metrics and KPIs to identify areas for improvement, fostering a culture of continuous growth and accountability. Manage stakeholder relationships, ensuring transparent communication and alignment with business goals. Additionally, allocate resources effectively to optimize productivity, mitigate risks, and drive sustainable success in a dynamic environment.
Care Management involves conducting thorough due diligence to ensure that all undertakings align precisely with policy provisions. Additionally, the role requires verifying that decline decisions are both accurate and reflect a correct interpretation of the policy guidelines.
Maintain compliance with established Turnaround Times when granting approvals to ensure efficiency and adherence to deadlines.
We require medical clarifications, including medical reports and copies of investigation reports from healthcare providers, in accordance with established protocols.
Maintaining broker and customer relations involves promptly relaying all essential claim decisions to clients to ensure they remain informed and up-to-date.
Collaborate with the claims team to furnish any necessary details regarding claims submissions, ensuring that modifications to previously provided information are accurately addressed.
Engaging with clients, brokers, and providers as necessary, the role involves addressing issues in compliance with legal, ethical, and policy-defined standards to ensure consistent and principled resolutions.
We proactively collaborate with providers to discuss pricing structures, including cost considerations, negotiated discounts, pre-established rates, bundled packages, fixed-fee arrangements, and average-cost agreements.
Maintain meticulous accuracy in system data entry and process all benefit adjudication cases with absolute precision to prevent any errors.
Facilitating communication with the underwriting department to establish the scope of cover for diverse schemes.
We collaborate closely with the Provider Relations team to address inquiries related to the provider panel, customer complaints, and other relevant matters.
Overseeing the round-the-clock emergency helpline operation, you will ensure seamless communication and rapid response to critical inquiries. This pivotal role demands vigilance and the capacity to coordinate effectively under pressure, as you will be responsible for directing calls to appropriate personnel, documenting incidents, and providing immediate assistance as necessary. Your expertise will be essential in maintaining the integrity and efficiency of the emergency response system.
The department’s strategic initiatives will be executed, incorporating recommendations provided by the Claims Quality Assurance Committee.
Drive all customer service metrics to achieve a Net Promoter Score (NPS) within the specified scope.
Ensure strict compliance with internal business processes, IRA regulations and guidelines, as well as adherence to the ethical standards established for the department.
Client presentations and member education initiatives focus on promoting prudent utilization practices and effective risk management strategies.
The care management team will receive comprehensive support to guarantee the timely completion of all deliverables within the specified turnaround time.
A strong candidate must possess a comprehensive set of technical and interpersonal skills, including proficiency in data analysis, project management, and stakeholder communication. Essential requirements encompass a minimum of five years of relevant experience in a similar role, along with a bachelor’s degree in a related field. Additionally, familiarity with industry-standard software and tools, such as advanced Excel, CRM platforms, and data visualization tools, is mandatory. Strong problem-solving abilities, adaptability, and a collaborative mindset are also critical for success in this position.
Manages the administration and strategic oversight of the organization’s health benefits programs, ensuring alignment with regulatory standards and employee needs. Develops, implements, and monitors benefit plans to optimize cost efficiency while maintaining high-quality coverage. Collaborates with insurance providers, brokers, and internal stakeholders to negotiate terms, resolve issues, and enhance plant performance. Conducts regular audits and data analysis to assess utilization trends, identify cost-saving opportunities, and ensure compliance with legal requirements. Communicates plan details, changes, and enrollment processes clearly to employees, promoting understanding and engagement. Leads vendor management activities, including contract reviews, performance evaluations, and renewal negotiations, to secure favorable terms and service levels.
Policy Interpretation involves analyzing and clarifying complex regulations, statutes, and guidelines to ensure accurate application in various contexts. This role requires a deep understanding of legal frameworks, strong analytical skills, and the ability to communicate intricate concepts in accessible terms. Responsibilities include advising stakeholders on compliance requirements, resolving ambiguities in policy documents, and developing interpretive guidelines to support consistent decision-making. Candidates should possess expertise in relevant legislative or regulatory areas, exceptional attention to detail, and proficiency in research methodologies to interpret evolving policies effectively. Strong written and verbal communication skills are essential for drafting clear, concise policy documents and facilitating informed discussions among diverse audiences.
Dedicated to delivering exceptional client support, this role emphasizes attentive service and a commitment to meeting customer needs. The position requires a proactive approach, strong interpersonal abilities, and the capacity to resolve inquiries efficiently. Responsibilities include addressing customer concerns, maintaining accurate records, and ensuring a positive experience throughout all interactions. Proficiency in communication, problem-solving, and adaptability is essential to thrive in this customer-centric environment.
We are seeking a highly motivated professional who demonstrates unwavering dedication and accountability in their role. The ideal candidate will bring a strong sense of responsibility to every task, ensuring consistent performance and reliability. Commitment to excellence and attention to detail are essential, as the position requires thorough execution of duties and adherence to established standards. This role demands perseverance, adaptability, and a proactive approach to overcoming challenges while maintaining a high level of professionalism.
We at Team Spirit are in search of a highly motivated and experienced individual to join our team. The ideal candidate will possess exceptional communication skills, strong leadership abilities, and a proven track record in collaborative environments. Prior experience in a related field is required, along with the capacity to work efficiently under pressure and meet tight deadlines. Responsibilities include overseeing team projects, fostering a positive work culture, developing strategic plans, and ensuring seamless coordination among team members. Proficiency in project management tools and a commitment to continuous professional growth are essential.
Excellent communication skills, both verbal and written, are essential for this role, ensuring clear and effective interactions with team members, clients, and stakeholders. The ability to articulate ideas persuasively and listen attentively is critical to fostering collaboration and achieving organizational goals. Additionally, strong interpersonal skills are required to build rapport, resolve conflicts, and maintain positive working relationships in a dynamic environment.
Proven capability to manage multiple tasks concurrently while maintaining attention to detail and meeting deadlines. Demonstrates organizational skills to prioritize workload effectively, ensuring efficient execution of diverse responsibilities without compromising quality.
Exceptional aptitude for negotiating effectively and making timely, well-informed decisions is essential.
Seeking candidates with a proven background in the specified field, demonstrating both theoretical understanding and practical application. Applicants should possess relevant professional experience, ensuring they are well-versed in industry standards and best practices. Familiarity with key methodologies, tools, or systems pertinent to the role is essential, along with the ability to apply this knowledge effectively in real-world scenarios.
A minimum of two years of professional experience in case management or a closely related field is required.
Proven expertise in overseeing the admission and discharge processes is required.
Academic and Professional Qualifications Required
Applicants must meet the following academic and professional requirements to be considered for this position. Candidates should possess a minimum of a bachelor’s degree in the relevant field, ideally supplemented by an advanced degree or specialized certification pertinent to the role. Additionally, a proven track record of professional experience in a related industry, typically spanning at least five years, is expected. Strong analytical, problem-solving, and communication skills are also essential, along with the ability to work collaboratively in a dynamic team environment. Familiarity with industry-specific tools, methodologies, or regulatory standards may be required, depending on the nature of the position.
A bachelor’s degree in nursing or clinical medicine is required for this position.
Applications must be submitted to the Group Human Resources Manager at Madison Group Limited via email at hr_recruitment@madison.co.ke no later than Wednesday, June 17th, 2026.
Qualifications
BA/BSc/HND
Experience Required
2 years
