Madison Group Care Manager – Kitale Branch Jobs in Kenya



Madison Group Care Manager – Kitale Branch Jobs in Kenya; Care management, handling outpatient, optical, and dental preauthorizations, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns.

  • Managing the 24‑hour emergency line.

    Key Responsibilities

  • Care management – through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise, for declines, ensuring that the decisions are accurate and a correct interpretation of the policy.

  • Ensure appropriate turnaround time is adhered to in issuing approvals.

  • Seek medical clarifications including medical reports, copies of investigation reports from providers as per standard procedure.

  • Broker/customer relations by communicating all necessary claim decisions to clients on a timely basis.

  • Work with the claims team and provide any information required in the claims submitted in cases where further information provided changes the position undertaken previously on the claim.

  • Interact with clients, brokers, and providers as needed, to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.

  • Engage providers on matters cost, discounts, pre‑agreed rates, packages, fixed cost, and average cost agreements.

  • Ensure accurate information is captured in the system and have a zero‑error rate in benefit adjudication of all cases.

  • Liaise with underwriting department on scope of cover for various schemes.

  • Liaise with provider relations section on matters pertaining to provider panel, customer complaints, etc.

  • Manage
    the 24‑hour emergency helpline.

  • Implement strategic initiatives for the department and recommendations by claims QA committee.

  • Achieve an NPS score on all customer service indicators.

  • Ensure compliance to internal business processes, IRA regulations/guidelines, and adherence to work ethics for the department.

  • Conduct client presentations and member education on wise utilization and risk management.

  • Support the care management team to ensure all deliverables are met within the given turnaround time.

    Skills and Competencies Required

  • Health benefits plan management.

  • Policy interpretation.

  • Customer service and focus.

  • Responsibility and commitment.

  • Team spirit.

  • Excellent communication.

  • Ability to multi‑task.

  • Strong negotiation and decision‑making skills.

    Knowledge and Work Experience

  • At least 2 years’ case management or relevant experience.

  • Demonstrated knowledge of managing admissions and discharges.

    Academic and Professional Qualifications Required

  • Bachelor’s degree in Nursing or Clinical Medicine.

    How to apply

    For more information and job application details, see; Madison Group Care Manager – Kitale Branch Jobs in Kenya

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