Case Management Clinical Executive

Lets Write Africa's Story Together!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

To control and manage medical benefit utilization through preauthorization and case management activities and ensure quality, appropriate cost-effective care and good customer service

1. KEY TASKS AND RESPONSIBILITIES

• Pre-authorize scheduled and non-scheduled admissions within the set guidelines
• Negotiate/discuss professional fees as appropriate for each admission
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
• Visit all admitted clients within Nairobi region and its environ
• Liaise with Doctors on the day-to-day management of patients and obtain medical reports/ expected length of stay where indicated
• Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care
• Revise reserves after discharge of member
• Collect feedback from admitted clients on quality and scope of service by the service provider
• Assist in carrying out verification and medical audit of claims/invoices before settlement
• Develop and maintain monthly database on admissions, large claims and extended length of stay.
• Respond to queries from clients, intermediaries and service providers
• Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products
• Any other duty assigned by management

2. SKILLS AND COMPETENCIES

• Excellent communication and negotiation skills
• Excellent public relations and interpersonal relationship skills
• Extensive networking with SP and other medical insurers
• Excellent analytical and monitoring skills
• Good IT skills in database management and office systems
• Good decision making in benefit utilization management
•  High levels of integrity and honesty

3. QUALIFICATIONS, KNOWLEDGE & EXPERIENCE

• Diploma or Degree in Nursing                     
• Diploma in Insurance/ COP
• Degree in Health systems Management/ Business management 
• 3 years’ experience in clinical setting +2 years in insurance set up

4.ANTI-MONEY LAUNDERING (AML) EXPECTATION

The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.

Skills

Consultative Selling, Customer Complaint Management, Customer Feedback Management, Customer-Focused, Customer Relationship Management (CRM) Software, Customer Service, Customer Service Operations, Customer Understanding, Data Management, Digital Consumer Engagement, Identifying Sales Opportunities, Probing Questions, Sales Data Management, Strengthening Customer Relationships, Upselling

Competencies

Action Oriented

Communicates Effectively

Customer Focus

Decision Quality

Ensures Accountability

Interpersonal Savvy

Manages Ambiguity

Manages Complexity

Education

NQF Level 3 & NQF Level 2 - Below school leaving

Closing Date

18 May 2026 , 23:59

The Old Mutual Story!