Care Officer – Case Management at GA Insurance
Care Officer – Case Management
About the position
Job Summary:
The primary purpose of the Care officer role is to deliver
clinical oversight and case management for insured members requiring
hospitalization. The role is responsible for ensuring that members receive
medically appropriate, high-quality, and cost-effective care, while also
safeguarding the financial sustainability of the medical scheme. This includes
evaluating pre-authorizations, monitoring inpatient admissions and coordinating
with healthcare providers. The position requires strong clinical acumen, a deep
understanding of medical insurance operations, benefit structures, and
regulatory requirements.
Duties and Responsibilities:
- Ensure
proper care and treatment of patient within acceptable protocols to
mitigate overuse of cover by member / provider
- Vet
and review claim documents with the goal of determining the validity as
reported in the claim form to determine eligibility including validity and
benefits as per policy guidelines
- Prepare
daily reports of admissions in the various service providers
- Attend
to all our customers and ensure complicated and disputed cases at the call
centre are escalated and resolved within the agreed timelines.
- Undertake
timely claims processing within the timelines of provider payment
schedules
- Obtain
additional required information on claims from providers, brokers or
clients by going through pre-authorization forms and scrutinize forms for
correct diagnosis
- Undertaking
patient visits to ensure quality service, correct treatment and
eligibility where required explain the medical terms of cover or where
queried
- Inform
the provider manager / provider management team on any anomalies of
provider service / quality concerns
- Review
and resolution of complex cases and provide appropriate clinical expertise
on diagnosis / treatment within policy coverage including where clients
require medical guidance and escalate where necessary
- Interact
with clients, brokers and clinicians as needed, informing them as
necessary admission claim decisions on a timely basis, to resolve problems
within the guidelines of the policy and escalate where necessary
- Liaise
with underwriting section on clarity of scope and omission
- Provide
support in the preparation of client presentations and member education on
wise usage of cover
Academic and Professional Qualifications
- Bachelor’s
degree/Diploma in nursing or clinical medicine, or a related field.
- Professional
Nursing qualification KRCHN licensed by Nursing council of Kenya.
- Relevant
certifications in case management, healthcare management, or clinical
specialties.
Experience
- At
least 3 years’ case management experience in a medical insurance
environment, with demonstrated expertise in inpatient care coordination,
insurance benefit administration, policy interpretation, and
pre-authorization processes.
- Demonstrated
knowledge of managing admissions and discharges
- Experience
in provider engagement will be an added advantage.
Technical Competencies
- Experience
in managing stakeholders in the health insurance services ecosystem
- Clinical
knowledge and ability to interpret medical reports and treatment plans
- Understanding
of health insurance policies, benefits, and scheme structures
- Strong
case management and utilization review skills
- Analytical
thinking and sound decision-making based on clinical and policy guidelines
- Attention
to detail and accuracy in documentation and benefit adjudication
- Excellent
communication and interpersonal skills for engaging clients, providers,
and internal teams
- Customer
service orientation with empathy and professionalism
- Negotiation
and relationship management skills with service providers and stakeholders
- Knowledge
of compliance requirements, medical ethics, and healthcare regulations
- Ability
to identify and mitigate fraud, waste, and abuse in claims
- Knowledge
of emerging trends and procedures in health insurance services management
- Working
knowledge of diagnostic procedures within the Kenya healthcare system
Behavioural Competencies
- Strong
customer service
- Strong
analytical and problem-solving skills
- Results
driven and action oriented
- Collaborative
team player
- Strong
attention to detail
- Agile
mindset with demonstrated ability to manage tasks with competing deadlines
- High
degree of emotional intelligence, integrity, trust and dependability
- Ability
to work independently as well as part of a team
Application Procedure:
If you meet the above requirements and wish to be part of
our vibrant team in Care team, Health Department please send your application
letter and updated CV to the email address careers@gakenya.com by 11th February
2026.Interview will be on rolling basis. Indicate the position you are
applying for on the email subject line. Only shortlisted candidates will be
contacted.
Provider Relations Officer – Health at GA Insurance
Job Summary: The job holder will develop,
manage, and sustain relationships with healthcare provider networks to secure
high-quality and cost-effective health care services. The main goal is to shape
a comprehensive and integrated health care system by fostering a seamless and
efficient service network.
Duties and Responsibilities:
- Strategic
Partnerships – continuous engagement with providers to ensure provision of
high-quality, cost-effective care.
- Provider
network management – maintain an updated provider panel, monitor adequacy
of providers in all key regions and conduct provider audits. Update
provider panel and Contacts to ensure the list is current and up to date.
- Provider
relationship management – Develop and maintain strong provider
relationships to enhance provider and customer experience and to ensure
that providers adhere to the contract terms. Organize service meetings,
training on GA processes, obtain provider feedback and share relevant
reports on providers.
- Provider
contracting –assist in contracting of providers and managing the provider
contract lifecycle. While also ensuring all current and upcoming providers
have signed contracts and have submitted all relevant documentation,
carrying out system updates and filing of all relevant provider KYC
documents and maintaining reports for the same.
- Customer
service support – Support the business development and underwriting team
through attending client service meetings to ensure delivery of superior
customer experience.
- Compliance-
Participate in collection and system updates of provider KYC and licenses
to ensure compliance to any regulatory or health sector changes e.g.,
changes in the health legislation affecting the business and provide
compliance reports promptly and as required.
- Cost
containment- Negotiate costs, analyze provider costs, claims, and provide
prompt reports and data to inform decision making in scheme cost controls.
- Assist
in carrying out country-wide provider audits to ensure that quality, cost
effective medical services can be guaranteed for clients.
- Provide
guidance to, claims team, and contact centre agents on provider issues.
Academic and Professional Qualifications
- Diploma/bachelor’s
in nursing or clinical medicine is preferred.
- Any
insurance certification will be an added advantage
Experience
- At
least 5 years of experience in clinical management or similar role
- Prior
relevant experience in health insurance is preferred.
- Extensive
knowledge of public and private healthcare providers in Kenya
Technical Competencies
- Proficiency
in MS Package
- Experience
in managing health insurance medical scheme services
- Knowledge
of insurance industry and concepts and regulatory requirements
- Demonstrated
experience in provider onboarding requirements in health insurance
services management
- Working
knowledge of diagnostic procedures within the Kenya healthcare system
- Experience
in claims management within provision of medical scheme/ health insurance
- Knowledge
of emerging trends and procedures in health insurance services management
- Experience
in managing stakeholders in the health insurance services ecosystem
- Extensive
networking with SP and other medical insurers.
- Excellent
analytical and monitoring skills
- Good
decision-making skills.
Behavioural Competencies
- Strong
strategic focus and vision driven
- Strong
problem solving, conflict management and decision-making capability
- Ability
to build strategic relationships and network.
- Demonstrated
team spirit and experience in team management through effective delegation
and collaboration.
- High
emotional intelligence and diplomatic sensitivity
- Ability
to effectively manage resources.
- Ability
to coach, mentor and develop talent.
- Strong
interpersonal and communication skills.
- Strong
client focus.
- High
level of trust, integrity and dependability
- Innovative
and ability to challenge the status quo.
How to Apply
If you meet the above requirements and wish to be part of
our vibrant team in Provider support management team, Health Department please
send your application letter and updated CV to the email address careers@gakenya.com by 11th February
2026.Interview will be on rolling basis. Indicate the position you are
applying for on the email subject line. Only shortlisted candidates will be
contacted.
Business Development Officer – Health Insurance Business at GA Insurance
About the position
Job Summary:
This position is responsible for the growth of Health
business revenue as per the annual premium targets set through maintaining a
high retention, new account acquisition and Key Account Management.
Duties and Responsibilities:
- Responding
to incoming calls, letters, e-mails from clients/ intermediaries on health
covers/coverage within set TAT’s and attend to walk in clients promptly
and professionally.
- Service
existing health business as the primary Key Accounts Managers. Maintain
excellent customer service and escalate complaints
- Marketing
- Provide
quotations as per guidelines and authority limits
- Close
new accounts
- New
business as per target set
- Intermediary
management from creation/adoption and ensure they are active.
- Preparation
and participation in tendering process, securing and management of the
account
- Set up
cover terms (product in the system) for all new clients.
- Sending
out and follow up of renewal business two months in advance and ensure
renewal retention of 85% and organic growth targets are met
- Ensure
proper documentation as per new business, funds & renewal business to
ensure correct set up of new accounts/schemes & products in the system
and advise underwriter on cover terms.
- Ensure
we achieve a good score on audit/ risk and all issues are resolved
- Member
education/ training on policy terms for our clients.
- Maintain
acceptable loss ratios as per company appetite
- Ensure
all policy files are in proper up to date record
- Updating
membership listing to all providers
- Quarterly
reports and ad hoc report requests to clients
- Respond
to audit queries, ensure we achieve a good score on audit/ risk and all
issues are resolved
- Facilitating
risk controls
- Maintaining
and observe the present standard guidelines as stipulated in the health
procedural manual.
- Ensuring
compliance with company procedures and insurance regulatory guidelines.
- Ensure
debt collection in line with our credit control policy
- Following
up on premium payments based on the dr/ cr notes raised and shared with
the client.
- Liaising
with credit control to ensure acceptable levels of debt as defined by
company manual.
- Verifying
premium payment document(s) e.g. ipf to ensure the same is approved by the
head of department and submitted to accounts team for financing to be
effected accordingly.
- Facilitating
renewal
- Sharing
renewal invitation- preparation and sharing of renewal invitations to
clients based on the stipulated TATs.
- Taking
part in renewal negotiations- attending client renewal meetings and
discussions based on the performance of the scheme in order to renew.
- Facilitate
corporate scheme performance review meetings quarterly or half yearly
meetings advice on mitigation measures where adverse
- Participate
in the improvement of current product scope by benchmarking with market
trends and actuarial advisory.
- Facilitate
collection and updating of all clients KYCs documentation when onboarding
risks as per company guidelines.
- Advise
cover terms to underwriter.
- Prepare
weekly Quotation reports as required against the projected target.
- Respond
to from clients and escalate where and when necessary.
- Medical
products presentations to various intermediaries
- Member
Education on policy benefits to various clients
Academic and Professional Qualifications
- Bachelor’s
degree in marketing, Insurance, or business-related discipline.
- Progress
towards Diploma in Insurance (ACII or AIIK), at least 3 papers or
equivalent)
Experience
- 3
years in health insurance, and/or,
- At
least 5 years as a Key Accounts Manager in the Finance Industry.
- Local
Expertise: must have experience in sales in Mombasa region.
Competencies:
Technical Competencies
- Excellent
Sales and marketing skills
- Knowledge
of health insurance products
- Knowledge
of insurance concepts and procedures
- Excellent
Customer service
- Knowledge
of insurance regulatory requirements
- Proficient
in certain professional skills such as MS Packages, report writing,
budgeting knowledge and basic market researching.
- Familiarize
with the current market conditions and trends.