Britam Corporate Care Management Associate - Jobs in Kenya

Britam Corporate Care Management Associate - Jobs in Kenya


Job Purpose:

Reporting to the Team Leader Corporate Care Management, the role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost-effective care.

Key Responsibilities

  • Set the appropriate parameters for each admission (claim reserve, initial authorized cost, and duration)
  • Interact with clients and service providers to ensure that the care is given within policy guidelines
  • Review medical reports and claims for compliance with set guidelines
  • Liaise with underwriters on the scope of cover for the various schemes
  • Ensure that medical scheme members are attended to round the clock with support from the 24-hour call center.
  • Poly-Pharmacy – discourages poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
  • Generic substitution – Encourage the use of generics was indicated as a method of reducing the organization's pharmaceutical expenditure.
  • Delegated Authority: As per the approved Delegated Authority Matrix
  • Prepare periodic reports for management on medical claims
  • Ensure claims are processed within the stipulated time
  • Perform any other duties as may be assigned from time to time.

    Key Performance Measures

  • As described in your Personal Score Card

    Knowledge, experience and qualifications required

  • Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
  • Moderate understanding of insurance concepts
  • Professional qualification in FLMI, ACII and IIK.
  • 5-8 years’ experience in case management two of which should be in a supervisory position.

    Leadership category responsibility framework (Core Competencies

    Emerging Leaders in Britam need to:


  • Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost, and team targets;
  • Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation;
  • Ensure that department priorities are adhered to and effectively communicated;
  • Ensure competent and effective people resources through appropriate coaching, development, and people supervision as appropriate;
  • Embody a high-performance, proactive culture;
  • Effectively ensure the adherence to key performance areas, deadlines, and goals in order to optimize operational effectiveness;
  • Effectively communicate resource needs, possible opportunities, and achievements to management in order to aid them in their decision-making;
  • Effectively set and monitor priorities and objectives for more junior staff;
  • Understand and communicate objectives in relation to the larger organizational impact;
  • Effectively disseminate knowledge within the correct context, towards subordinates as well as management;
  • Appropriately model the company values while setting the pace and energy for delivering;
  • Effectively manage and communicate change within the department in order to increase staff and process effectiveness;
  • Provide access to accurate and consistent information and services across all channels;
  • Ensure a seamless experience for clients;
  • Improve service delivery for clients;
  • Engage in continuous brand building to become the trusted partners of clients

    Emerging Leaders Competency Descriptions.

  • Presenting and Communicating Information - Speaks fluently; expresses opinions, information, and key points of an argument clearly; presents effectively; responds quickly to others ‘reactions and feedback during conversations; projects credibility.
  • Working with People - Shows respect for the views and contributions of team members; shows empathy; listens, supports, and cares for others; consults others and pro-actively shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the
    team and fits in well.
  • Adhering to Principles and Values - Upholds and encourages ethical behavior and departmental values; demonstrates integrity; encourages individual responsibility towards the community and the environment; models the organizational values during everyday interactions.
  • Analyzing - Analyses numerical data and all other sources of information, breaking them into component parts, patterns and relationships; probes for further information or greater understanding of a problem; make rational judgments from the available information and analysis; demonstrates an understanding of how one issue may be part of a much larger system/process/problem.
  • Planning and Organizing - Adheres to and monitors clearly defined objectives; plans activities and projects well in advance and takes account of possible changing circumstances; identifies and organizes resources needed to accomplish tasks; manages time effectively; monitors performance against deadlines and milestones.
  • Delivering Results and Meeting Customer Expectations - Focuses on customer needs and satisfaction; sets and models high standards for quality and quantity; monitors and maintains quality and productivity; works in a systematic methodical and orderly way; consistently achieves projects goals.
  • Deciding and Initiating Action - Takes responsibility for own, as well as subordinates’ actions and projects; takes initiative and works under own direction; initiates and generates activity; introduces improvements into work processes; handles problems with minimal guidance.
  • Leading and Supervising - Provides subordinates with a clear direction; motivates and empowers others; provides subordinates with the relevant coaching; creates a positive climate that fosters learning and development; identifies high potential talent; sets and articulates the departmental vision and values through own personal behavior; set appropriate standards of behavior.
  • Formulating Strategies and Concepts - Works strategically to realize personal goals; understands and effectively communicates the departmental strategy; translates the departmental strategy and vision into operational.
  • Responsibilities; takes into consideration departmental strategy during all tasks; takes account of a wide range of issues across, and related to the current role.
  • Applying Expertise and Technology - Applies specialist and detailed technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organizational departments and functions.
  • Following Instructions and Procedures - Challenges authority only when appropriate; follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates a commitment to the organization; complies with legal obligations and safety requirements of the role.
  • Adapting and responding to change - Adapts to changing circumstances; tolerates ambiguity; accepts new ideas and change initiatives; adapts interpersonal style to suit different people or situations; shows an interest in new experiences.

    Technical/ Functional competencies

  • Knowledge of insurance regulatory requirements
  • Knowledge of insurance product
  • Sales and marketing management skills



    For more information and job application details, see; Britam Corporate Care Management Associate - Jobs in Kenya



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