Role Overview
This role coordinates healthcare access for medical insurance clients by working closely with members, intermediaries, healthcare providers, and internal teams. It applies nursing knowledge and insurance expertise to support suitable, timely, and cost-conscious care while contributing to customer retention and the performance of the medical business.
Key Responsibilities
- Coordinate with medical clients, intermediaries, and healthcare providers to help members access appropriate services promptly.
- Review medical claims and support their accurate, efficient processing in line with applicable policies.
- Interpret policy terms and explain relevant coverage to clients and service providers.
- Engage healthcare providers and intermediaries to resolve service or claims issues and improve care coordination.
- Use analytical skills to assess cases, identify concerns, and support sound decisions on medical services and claims.
- Negotiate and influence where needed to reach practical outcomes for customers and the business.
- Communicate clearly with customers and colleagues, providing professional service and maintaining effective working relationships.
- Contribute to processing across insurance classes and collaborate with the wider team to maintain service quality.
Requirements & Qualifications
- Bachelor’s degree or diploma in Nursing.
- Registration with the Nursing Council of Kenya.
- AIIK professional qualification.
- At least four years’ experience in health insurance.
- Working understanding of the insurance industry and claims management.
- Skills in policy interpretation, customer management, negotiation, analysis, and customer service.
- Strong communication and interpersonal skills, with fluency in relevant IT tools.
- Demonstrated integrity, reliability, transparency, professionalism, teamwork, and commitment to quality.
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