Job Openings at Madison Group Limited

About Madison Group Limited

Madison Group Limited is a leading financial services provider specializing in insurance and wealth management. It operates through three key subsidiaries: Madison Life Assurance Kenya Limited, Madison General Insurance Kenya Limited, and Madison Investment Managers Limited. Established in 1988 following the merger of Crusader Plc (founded in 1974) and Kenya Commercial Insurance Corporation, the company has seen significant growth, expanding from KES 100 million in gross written premiums in 1988 to KES 6.2 billion by December 2017.

Care Manager (2 Positions)

Job Type: Part-Time
Qualifications: BA/BSc/HND, Diploma
Experience Required: 3 years
Location: Nairobi
Industry: Medical / Healthcare

Key Responsibilities

Oversee care management processes, ensuring that approvals and declines are aligned with policy terms and conditions.
Maintain adherence to turnaround time (TAT) for approvals and ensure prompt issuance of undertakings.
Request medical clarifications, including reports and investigative findings where necessary.
Communicate timely admission claim decisions to brokers and customers, ensuring transparency in the claims process.
Collaborate with the claims department, particularly in cases where additional information alters prior determinations on inpatient claims.
Assess and review medical pre-authorizations, ensuring compliance with policy guidelines.
Work closely with clients, brokers, and healthcare providers to address and resolve claim-related concerns in an ethical and policy-compliant manner.
Monitor hospitalized patients, ensuring they receive high-quality and cost-effective care.
Engage with healthcare providers on matters related to cost, discounts, pre-negotiated rates, treatment packages, and fixed cost models.
Verify membership validity and benefits coverage from scheme benefit files.
Handle inquiries regarding policy coverage from brokers, members, and healthcare providers.
Validate the legitimacy of medical services rendered, ensuring adherence to policy benefits and provider panel regulations.
Coordinate with brokers, clients, and medical facilities to collect any additional required information for claims processing.
Ensure accurate data entry into internal systems, maintaining a zero-error rate in benefit adjudication.
Collaborate with the underwriting department to clarify scope of cover for different schemes.
Liaise with the provider relations team to resolve customer complaints and manage provider panel relationships.
Conduct client presentations and member education sessions to promote efficient healthcare utilization and risk management.
Support the care management team to meet performance targets and ensure timely service delivery.

Required Skills & Competencies

Strong understanding of health benefits plan management.
Ability to interpret policy provisions accurately.
Customer service excellence and a client-centric approach.
High level of commitment and accountability.
Effective teamwork and collaboration.
Excellent communication and interpersonal skills.
Ability to handle multiple tasks simultaneously (multi-tasking).
Strong negotiation and decision-making abilities.

Knowledge & Experience

Minimum of 2 years’ experience in case management within a medical insurance environment.
Proven ability to handle hospital admissions and discharges in a fast-paced insurance setting.
Experience in negotiating costs with service providers and medical professionals.
Skilled in case management reporting, including hospital visits and virtual follow-ups for admitted patients.