Case Management Officer

Job Purpose

The role is focused on overseeing policy cases through structured case management so that Britam Microinsurance claims are handled with strong control, efficient service, appropriate cost management, and accurate processing and payment.

Key Responsibilities

• Establish suitable parameters for each admission, including the claim reserve, the first approved cost, and the expected duration.
• Work closely with clients and service providers to ensure treatment and care remain aligned with policy terms.
• Examine medical reports and claim submissions to confirm they meet the required guidelines.
• Coordinate with underwriters to clarify cover scope across the different schemes.
• Make sure scheme members receive support at all times through the 24-hour call centre.
• Reduce poly-pharmacy by carefully questioning prescriptions and recommending more suitable alternatives where appropriate.
• Promote the use of generic medicines when suitable in order to help control pharmaceutical spend.
• Check claim documents and all supporting requirements received from providers and clients.
• Confirm that each claim is complete and accompanied by the documents needed for an insurance claim.
• Maintain professional relationships with clients, intermediaries, and service providers.
• Verify and audit inpatient and outpatient claims to ensure adherence to procedures and reduce risk.
• Guide claimants on basic insurance cover matters related to their claim.
• Handle both internal and external questions about the claims process, service providers, and completion of required forms.
• Capture and maintain records of all claims transactions.
• Compile claims registers for meetings and keep claims reports current.
• Monitor outstanding documents and follow up to ensure they are received.
• Work within the approved Delegated Authority Matrix.
• Carry out any other related duties assigned from time to time.

Knowledge, Experience and Qualifications

• A professional nursing qualification (KRCHN) with valid registration/licensing from the Nursing Council of Kenya.
• Between 2 and 4 years of experience in case management and claims processing.
• Good understanding of insurance regulatory requirements.
• Working knowledge of insurance products.

Employment Details

This is a permanent, full-time day role based in Nairobi, Kenya.

Posting Status

The position was posted on 18 June 2026 and remains open on an ongoing basis.