Vacancies at Madison Group Limited

Madison Group Limited is a locally owned financial services holding company that specializes in Insurance and wealth management services. The Group comprises of Madison Life Assurance Kenya Limited, Madison General Insurance Kenya Limited, and Madison Investment Managers Limited. Madison Life Assurance Kenya was originally incorporated under Kenyan Laws in 1988 as Madison Insurance Company Limited (MICK) after a successful merger between Crusader Plc (1974) and Kenya Commercial Insurance Corporation.

Read more about this company

• Contents
• Open Jobs
  1. Senior Care Manager
  2. Assistant Underwriter – Healthcare
  3. Supervisor Care Management – Outpatient and Call Centre
• Method of Application

• Job TypeFull Time
• QualificationBA/BSc/HND
• Experience3 years
• LocationNairobi
• Job FieldInsurance&nbsp , Medical / Healthcare&nbsp

Overall Responsibility:

Care Management, handling Inpatient preauthorizations, and communicating with providers, clients, and brokers on a timely basis for any undertakings, rejections, or relevant concerns. Doing proper case management by doing physical visits and virtual follow up of all admitted members. Providing mentorship to the care managers in the team.

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.
• Seeking medical clarifications including medical reports, copies of investigation reports
• Broker/customer relations by communicating all necessary admission claim decisions on a timely basis.
• Work with the claims team and coordinating on any information noted in the claims especially inpatient claims submitted in cases where further information provided changes the position undertaken previously on the claim.
• Reviewing medical pre-authorizations for compliance with applicable policy guidelines.
• Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
• Visiting/engaging admitted patients and ensuring they receive quality and cost-effective quality care
• Engaging providers on matters cost, discounts, pre-agreed rates, packages, fixed cost model
• Checking and confirming membership validity and benefits (from the scheme benefits file)
• Handling of coverage enquiries with brokers, providers, members etc.
• Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
• Obtaining additional required information on claims from providers, brokers or clients
• Ensure accurate information is captured in the system and have a zero-error rate in benefit adjudication of all cases
• Liaising with underwriting section on scope of cover for various schemes
• Liaising with provider relations section on matters pertaining to provider panel, customer complaints etc
• Client presentations and member education on wise utilization & risk management
• Support the care management team to ensure all the deliverables are met within the given turnaround time

Skills and Competencies Required

• Health Benefits Plan Management
• Policy Interpretation
• Customer Service and Focus
• Ownership & commitment
• Team Spirit
• Excellent communication
• Ability to multi-task
• Strong negotiation and decision-making skills

Knowledge & Work Experience

• At least 3 years’ case management experience in a medical insurance environment, with at least 2 years as a care manager.
• Demonstrated knowledge of managing admissions and discharges in a busy insurance company
• Demonstrated experience in engaging service providers and doctors and negotiating cost
• Demonstrated experience in case management reports, physical visits, virtual follow up of admitted cases

Academic and Professional Qualifications required

• Bachelor’s degree in nursing or clinical medicine
• At least two-year’s experience in a care management role.

• Job TypeFull Time
• QualificationBA/BSc/HND
• Experience1 - 2 years
• LocationNairobi
• Job FieldInsurance&nbsp

Overall Responsibility:

Underwriting, vetting, pricing, set-up, renewal, servicing and support, reporting, documentation and management of schemes, and handling of related queries from clients and intermediaries on existing schemes

Key Responsibilities:

• Maintain detailed and accurate records of health business policies underwritten and decisions made.
• Assist in preparation of retail quotations within set standards.
• Ensure accurate and timely system entry/capture of medical benefits purchased and regular maintenance and update
• Ensure correct, prompt debiting and dispatch of premium invoices and the renewal/commencement premium schedules to the client/intermediary.
• Co-ordinate with the outsourced card production team on preparation of medical cards
• Handling queries from walk in clients, brokers, agents.
• Follow through the reports required by client/intermediary within the expected TATs and SLAs
• Preparing policy documents and endorsements and dispatch of the same to the relevant client
• Support duties for fellow underwriters as directed by the Supervisor
• Familiarize with system to note it’s extremes and what needs to be adjusted
• Handle reconciliation of premiums where disputes arise.
• Handle reconciliation of membership data to ensure accuracy.
• Liaise with the product and business development teams to evaluate the products
• Investigation of issues, an ability to recognize trends of issues and where other processes are going wrong – being proactive in recommending solutions.
• The team member will be expected to take ownership and seek to resolve queries.
• Liaising with the other departmental and company functions to ensure smooth delivery of services to insured clients.

Contacts arising from the Job (Key Relationships)

• Internal: All Staff and intermediaries
• External: Customers and intermediaries

Skills and Competencies Required

• Health Benefits Plan Management
• Database Administration
• Customer Service
• Continuous Innovation
• Excellent communication and multi-tasking skills
• Market Awareness
• Policy Processing
• Team Player
• Presentation Skills
• People management skills of both external and internal partners
• Integrity and honesty

Knowledge & Work Experience

• At least 1-2 years of experience in Healthcare Underwriting.
• Demonstrated experience engaging intermediaries.
• Developing and implementing operational procedures and policies.

Academic and Professional Qualifications required

• Degree in Actuarial Science/Statistics or Business-Related field.
• Progress in insurance professional course (AIIK or ACII) will be an added advantage.

• Job TypeFull Time
• QualificationBA/BSc/HND
• Experience1 year
• LocationNairobi
• Job FieldCustomer Care&nbsp , Insurance&nbsp , Medical / Healthcare&nbsp

Overall Responsibility:

• 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 and managing the 24-hour emergency line. Directly responsible to achieve the targets of the Outpatient Care Management department.

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.
• Seeking medical clarifications including medical reports, copies of investigation reports
• Broker/customer relations by communicating all necessary claim decisions on a timely basis.
• Work with the claims team and coordinating on any information noted in the claims especially inpatient claims submitted in cases where further information provided changes the position undertaken previously on the claim.
• Reviewing medical pre-authorizations for compliance with applicable policy guidelines.
• Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
• Engaging providers on matters cost, discounts, pre-agreed rates, packages, fixed cost model & other contractual agreements.
• Checking and confirming membership validity and benefits (from the scheme benefits file)
• Handling of coverage enquiries with brokers, providers, members, general public etc.
• Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
• Ensure accurate information is captured in the system and have a zero-error rate in benefit adjudication of all cases
• Obtaining additional required information on claims from providers, brokers or clients
• Liaising with underwriting section on scope of cover for various schemes
• Liaising with provider relations section on matters pertaining to provider panel, customer complaints etc
• Client presentations and member education on wise utilization & risk management
• Managing the 24-hour emergency helpline
• Support the care management team to ensure all the deliverables are met within the given turnaround time
• Implementation of strategic initiatives for the department and recommendations by claims QA committee.
• Achieve an NPS scope on all customer service indicators.
• Ensure weekly QA reports are issued on all key indicators.
• Compliance to internal business processes, IRA Regulations/guidelines and adherence to work Ethics for the department
• Staff development, mentorship and Retention.
• Closure of any Audit issues
• Leading the team to achieving the above and the departmental targets.

Contacts arising from the Job (Key Relationships)

• Internal: All Staff and intermediaries
• External: All Healthcare Service Providers, Customers and intermediaries

Skills and Competencies Required

• Health Benefits Plan Management
• Policy Interpretation
• Customer Service
• Team Management
• Cross-functional collaboration
• Excellent communication skills

Knowledge, Academic qualifications & Work Experience

• BSC Nursing/Clinical Medicine or relevant medical field.
• One-year experience in leading care management in health insurance.
• Experience in working in a medical call centre.

Method of Application

Applications should be addressed to the Group Human Resources Manager, Madison Group Limited, Email: hr_recruitment@madison.co.ke so as to be received by Friday 30 th May, 2025.