Primary Duties and Obligations: Oversee and execute a comprehensive range of critical tasks encompassing strategic planning, operational efficiency, and team leadership to drive organizational success. Key Responsibilities Include: Developing and implementing innovative business strategies aligned with long-term objectives, managing cross-functional teams to foster collaboration and productivity, and ensuring adherence to company policies and industry regulations. Additionally, the role demands meticulous attention to detail in financial management, including budget preparation, expense tracking, and performance analysis, as well as maintaining transparent communication channels with stakeholders to facilitate informed decision-making. The position requires a proactive approach to problem-solving, the ability to analyze complex data to identify trends and opportunities, and a commitment to continuous improvement initiatives that enhance overall business performance.
Care Management involves processing preauthorizations for Outpatient, Optical, and Dental services, ensuring prompt communication with providers, clients, and brokers regarding any actions taken, rejections, or critical concerns. Additionally, the role includes overseeing the 24-hour emergency line to address urgent matters efficiently.
Oversee daily operations to ensure efficiency and adherence to established protocols, managing workflows and coordinating team efforts to meet organizational objectives. Develop and implement strategic plans that enhance productivity while maintaining high-quality standards across all projects. Collaborate with department heads to align resources and optimize processes, fostering a culture of continuous improvement and innovation. Monitor performance metrics to identify trends, address challenges, and implement corrective actions as needed to sustain operational excellence. Lead cross-functional teams, delegate tasks effectively, and provide mentorship to cultivate leadership and professional growth among employees. Ensure compliance with industry regulations and internal policies to mitigate risks and uphold the organization’s reputation. Act as a liaison between executive leadership and staff, communicating priorities and fostering transparency while driving accountability at all levels.
Care Management involves meticulous due diligence to ensure that policy-driven undertakings are issued in strict adherence to the outlined provisions. Additionally, for declined cases, it is essential to verify that decisions are not only accurate but also reflect a precise interpretation of the policy guidelines.
Maintain adherence to established Turnaround Time standards when issuing approvals.
We require medical clarifications, such as medical reports and copies of investigation reports from healthcare providers, in accordance with established protocols.
Broker/customer relations entails promptly conveying all pertinent claim decisions to clients in a clear and timely manner.
Collaborate with the claims team to supply any necessary details regarding claims, ensuring adjustments are made to previously determined positions whenever additional information is provided.
Interacting with clients, brokers, and providers as required, you will address issues in compliance with legal, ethical, and policy-driven standards.
We collaborate with providers to negotiate and finalize terms related to cost structures, including discounts, pre-established rates, bundled packages, fixed-cost arrangements, and average-cost agreements.
Ensure all information entered into the system is precise and maintain a flawless record in benefit adjudication for every case processed.
Collaborating closely with the underwriting team to define the parameters of coverage for multiple initiatives.
The incumbent is responsible for collaborating with the provider relations division to address issues concerning the provider panel and customer complaints.
You will oversee the operation of the 24-hour emergency helpline, ensuring seamless and efficient management of all incoming inquiries and urgent support requests. Your responsibilities will include maintaining a high standard of service, coordinating responses with relevant teams, and guaranteeing timely assistance to callers in critical situations. Additionally, you will monitor performance metrics to identify areas for improvement and implement strategies to enhance overall helpline effectiveness.
Spearheading strategic initiatives for the department in alignment with the recommendations provided by the Claims Quality Assurance Committee is a key responsibility of this role.
Deliver a Net Promoter Score (NPS) within the targeted range for all customer service metrics.
Ensuring strict compliance with internal business processes, IRA regulations and guidelines, as well as upholding the ethical standards of the department is essential for this role.
Client presentations and member education sessions are conducted to promote prudent utilization and effective risk management strategies.
Collaborate with the care management team to guarantee the timely completion of all deliverables within the specified timeframe.
Proven expertise in identifying and leveraging core skills that align with organizational objectives is essential. The ideal candidate must demonstrate proficiency in key competencies required for the role, including analytical thinking, problem-solving, and effective communication. Additionally, familiarity with industry-specific tools and methodologies, as well as a commitment to continuous professional development, are critical. Strong interpersonal abilities and the capacity to work collaboratively within cross-functional teams are also imperative.
Health Benefits Plan Management involves overseeing and administering comprehensive health benefits programs, ensuring they meet organizational and employee needs while remaining compliant with regulatory standards. This role requires a strong understanding of healthcare plans, including medical, dental, and vision coverage, as well as expertise in benefits administration, vendor negotiations, and cost containment strategies. Responsibilities include evaluating plan options, managing enrollment processes, resolving employee inquiries, and ensuring seamless integration with payroll and HR systems. Candidates should possess a bachelor’s degree in human resources, business administration, or a related field, along with relevant certifications such as PHR, SHRIMP, or CABS, and a minimum of 3–5 years of experience in benefits administration or a similar capacity.
Experts in policy analysis are responsible for interpreting, clarifying, and applying organizational policies to ensure compliance and operational efficiency. This role involves examining policy documents in detail, resolving ambiguities, and providing guidance to stakeholders to align with regulatory standards and internal guidelines. Strong analytical skills, attention to detail, and the ability to communicate complex information clearly are essential. Candidates must possess a background in policy, law, or a related field, along with experience in policy development or implementation.
Dedicated to delivering exceptional customer experiences, this role prioritizes attentive service and a client-centric approach. Responsibilities include addressing inquiries, resolving issues promptly, and ensuring high levels of satisfaction. Strong communication skills and a problem-solving mindset are essential to meet customer needs effectively. Proficiency in handling multiple interactions while maintaining professionalism is required. A commitment to continuous improvement and a passion for service excellence drive this position.
Seeking a focused and dedicated professional to uphold accountability and execute duties with unwavering dedication, ensuring alignment with organizational objectives. The ideal candidate must demonstrate reliability, consistency, and a proactive approach to fulfilling assigned tasks while maintaining high standards of performance. Essential requirements include adherence to deadlines, attention to detail, and the ability to collaborate effectively within a team dynamic. This role demands a strong work ethic, adaptability to changing priorities, and a commitment to continuous improvement in all areas of responsibility.
We value your ability to foster a collaborative and inclusive environment where teamwork thrives. Your role involves promoting unity, encouraging mutual support, and ensuring every team member feels valued and motivated. You will be responsible for organizing team-building activities, mediating conflicts, and maintaining open communication channels to strengthen relationships. Additionally, you will assess team dynamics, identify areas for improvement, and implement strategies to enhance productivity and morale. Strong interpersonal skills, emotional intelligence, and a commitment to collective success are essential for this position.
Excellent interpersonal and written skills are essential for fostering collaboration and conveying information effectively. The ability to articulate ideas clearly, engage stakeholders, and tailor communication to diverse audiences is critical. Strong listening skills and adaptability in professional interactions further enhance teamwork and problem-solving capabilities.
Demonstrates exceptional skill in managing multiple responsibilities simultaneously while maintaining high efficiency and organization.
Exceptional proficiency in negotiation and decisive judgment is essential, along with the ability to evaluate options swiftly and act with conviction to achieve optimal outcomes.
A background in the relevant field and prior work experience are essential prerequisites for this role. Candidates must possess a comprehensive understanding of industry practices, standards, and emerging trends to drive effective decision-making and innovation. The ideal applicant will have a proven track record of success in similar positions, demonstrating the ability to meet or exceed performance expectations. Additionally, familiarity with key processes, tools, and methodologies relevant to the position is required to ensure seamless integration and productivity.
Minimum of two years of professional experience in case management or a closely related field is required.
Possesses proven expertise in overseeing the entire process of patient admissions and discharges, ensuring accuracy, efficiency, and adherence to established protocols.
Academic and professional qualifications necessary for this role include a relevant degree in [specified field], along with specialized certifications or licenses as mandated by the industry. Candidates should possess a minimum of [X] years of professional experience in a comparable position, complemented by a proven track record of [specific skills or achievements]. Additionally, fluency in [required languages, if applicable] and proficiency in [specific software/tools] are essential. Strong analytical, problem-solving, and communication abilities are also required to excel in this position.
A bachelor’s degree in nursing or a related field of clinical medicine is required.
Applications must be submitted to the Group Human Resources Manager at Madison Group Limited via email at hr_recruitment@madison.co.ke by the deadline of Wednesday, June 17th, 2026.
Qualifications
BA/BSc/HND
Experience Required
2 years
