Internship | Job Vacancies at Afia Concept Claims Settling Agency

Transform Healthcare Administration with Intelligence

Next-generation healthcare claims and care management platform — streamlining payers, providers, and patients with intelligent, secure, and connected digital workflows.

Care Manager at Afia Concept Claims Settling Agency

Mid-Level | 2+ years | Nairobi, Kenya | Reports to Care Management Team Leader

Apply for this role | Download JD (PDF)

Applications close on 2 November 2026

Role Purpose

The Care Manager is a clinically trained professional at the heart of ACS's medical operations function. The role carries three interconnected responsibilities: adjudicating pre-authorizations with speed and clinical accuracy, negotiating medical costs with healthcare providers during active admissions and service delivery, and providing sound clinical guidance to members navigating the healthcare system.

A particularly critical aspect of this role is the ability to step down care — identifying situations where a member can receive equivalent quality of treatment at a more cost-effective facility or care setting, and facilitating that transition in a way that is clinically safe, member-centred, and clearly communicated. The Care Manager must balance advocacy for the member's health outcomes with stewardship of scheme sustainability.

The ideal candidate is a clinically confident, commercially aware healthcare professional — typically a registered nurse or clinician with managed care experience — who can make sound, defensible clinical decisions under time pressure while maintaining strong relationships with providers, members, and internal teams.

Key Accountabilities

Care Coordination & Case Management

• Coordinate and manage care plans for assigned members.
• Conduct clinical assessments and evaluate members' healthcare needs.
• Monitor admissions, ongoing treatment, referrals, and discharge processes.
• Facilitate continuity of care across healthcare providers and service points.
• Ensure timely escalation of critical and emergency cases.

Utilization Management

• Review treatment plans to ensure appropriateness, quality, and cost-effectiveness.
• Facilitate pre-authorizations and care approvals in accordance with clinical guidelines.
• Monitor healthcare utilization and identify opportunities for cost containment.
• Support interventions aimed at reducing unnecessary admissions and readmissions.

Provider & Stakeholder Engagement

• Liaise with healthcare providers to coordinate member care and treatment plans.
• Collaborate with internal teams to ensure seamless service delivery.
• Participate in provider engagements, case reviews, and clinical discussions.
• Foster positive relationships with members, providers, and other stakeholders.

Chronic Disease & Wellness Management

• Monitor high-cost, chronic, and complex medical cases.
• Support disease management and wellness initiatives.
• Promote preventive healthcare and member education programs.
• Guide members on available healthcare resources and treatment options.

Member Advocacy & Experience

• Act as an advocate for members throughout their healthcare journey.
• Provide guidance on benefit utilization and access to care.
• Address member concerns and facilitate timely resolution of service issues.
• Support initiatives aimed at improving member satisfaction and outcomes.

Clinical Quality & Compliance

• Ensure adherence to clinical protocols, policies, and regulatory requirements.
• Participate in clinical audits, quality reviews, and risk management activities.
• Monitor quality indicators and recommend improvement initiatives.
• Support implementation of evidence-based clinical practices.

Reporting & Documentation

• Maintain accurate and up-to-date clinical records and case documentation.
• Prepare care management, utilization, and case review reports.
• Track and report on key care management metrics and outcomes.
• Ensure confidentiality and proper management of member information.

Key Performance Indicators

• Member Care Coordination
• Quality of Clinical Outcomes
• Case Management Effectiveness
• Timeliness of Pre-Authorizations
• Member Satisfaction
• Care Plan Compliance
• Hospitalization and Readmission Management
• Utilization Management Effectiveness

Qualifications

• Bachelor's Degree or Diploma in Nursing, Clinical Medicine, Medicine, Pharmacy or a related healthcare field.
• Valid professional registration and licensing where applicable.

Added Advantage

• Professional qualification in AIIK, ACII, or Certificate in Insurance.
• Formal training in customer experience or call centre operations.
• Knowledge of medical scheme operations, SLAs, and healthcare provider management.
• Understanding of ISO Quality Standards and Data Protection Act compliance.

Experience

• Minimum of 2 years' experience in case management, utilization management, clinical care, managed care, medical insurance, or healthcare administration.
• Experience in a medical insurance, TPA, healthcare management, or managed care environment is preferred.
• Knowledge of healthcare benefits, pre-authorizations, and clinical protocols.

Apply: Care Manager — Careers at ACS

Call Centre Executive (Clinical) at Afia Concept Claims Settling Agency

Mid-Level | 2+ years | Nairobi, Kenya | Reports to Care Management Team Leader

Apply for this role | Download JD (PDF)

Applications close on 2 November 2026

Role Purpose

The Call Centre Executive serves as the first point of contact for members, delivering professional customer service while addressing general clinical enquiries. Leveraging a clinical background, the role provides accurate guidance, resolves medical queries at first contact where appropriate, and escalates complex cases when necessary. The role combines strong customer service skills with sound clinical judgement to enhance member experience, improve response times, and support efficient healthcare service delivery.

Key Accountabilities

Call Centre Operations

• Handle inbound and outbound calls, emails, and messages from members, providers, clients, and other stakeholders in a professional and timely manner.
• Provide accurate information on scheme benefits, exclusions, processes, and services, resolving enquiries at first contact wherever possible.
• Escalate complex or unresolved queries to the appropriate teams and follow through to timely resolution.
• Accurately record all customer interactions, enquiries, resolutions, and escalations in the call centre system.
• Achieve agreed service standards and key performance indicators, including response times, first contact resolution, call quality, and customer satisfaction.

Clinical Support & Medical Query Resolution (where applicable)

• Assess and triage medical enquiries, applying clinical judgement to determine the appropriate course of action.
• Resolve routine clinical queries at first contact and escalate complex cases to the appropriate clinical team.
• Advise members on appropriate healthcare providers, levels of care, and available scheme benefits.
• Identify members requiring urgent or emergency care and facilitate prompt referral or escalation.
• Adjudicate outpatient pre-authorizations within the approved authority limits and escalate cases outside the approval matrix.

Member Experience & Relationship Management

• Deliver a professional, empathetic, and member-centered experience across all interactions.
• Build member trust by providing accurate information, clinical guidance, and responsive support.
• Follow up on unresolved queries, complex cases, and recent admissions to ensure continuity of care and service.
• Capture member feedback and escalate recurring issues or complaints to support service improvement.
• Promote a positive member experience by ensuring timely communication and effective resolution of enquiries.

Documentation & Compliance

• Maintain accurate and complete records of all clinical advice, member interactions, and related activities.
• Ensure compliance with data privacy, confidentiality, and health information protection requirements.
• Adhere to internal policies, clinical protocols, escalation procedures, and quality standards.
• Participate in call audits, quality assurance reviews, and performance improvement initiatives.
• Support continuous improvement by implementing feedback and maintaining professional standards.

Team Collaboration & Knowledge Sharing

• Collaborate with internal teams to ensure seamless coordination of member care and service delivery.
• Share insights from member enquiries to support process improvements, training, and knowledge resources.
• Support the onboarding and development of team members by sharing clinical knowledge and best practices.
• Participate in team meetings, training sessions, and clinical updates to maintain professional competence.
• Contribute to continuous improvement initiatives that enhance service quality and operational efficiency.

Reporting & Continuous Improvement

• Track and report on medical query volumes, first-contact resolution rates, and escalation patterns.
• Identify trends in member queries that may indicate gaps in benefit communication, scheme design, or provider service quality.

Key Performance Indicators

• Customer Satisfaction (CSAT)
• First Contact Resolution (FCR)
• Call Quality Audit Score
• Clinical Query Accuracy
• Pre-authorization Decision Accuracy
• Service Level Compliance
• Call Documentation Accuracy
• Data Privacy and Regulatory Compliance

Qualifications

• Diploma or Bachelor's degree in Nursing, Clinical Medicine, Public Health, or Healthcare Management or equivalent.

Added Advantage

• Professional qualification in AIIK, ACII, or Certificate in Insurance.
• Formal training in customer experience or call centre operations.
• Knowledge of medical scheme operations, SLAs, and healthcare provider management.
• Understanding of ISO Quality Standards and Data Protection Act compliance.

Experience

• Minimum of 2 years' relevant experience in medical insurance administration, provider relations, or healthcare scheme management, preferably within an insurance company, brokerage firm, or medical service provider network.
• Experience in a customer-facing, call centre, telehealth, or health insurance environment is an added advantage.

Core Competencies

• Strong background in medical insurance servicing, including healthcare claims, member and provider management.
• Excellent communication, interpersonal, and client relationship skills.
• High integrity, professionalism, and strict commitment to patient and member confidentiality.
• Ability to translate complex clinical or benefit information into clear, plain-language communication for members and providers.
• Excellent verbal communication, active listening, and empathy skills — particularly in handling distressed, unwell, or frustrated callers.
• Strong understanding of health insurance concepts including claims, pre-authorizations, benefit limits and exclusions.
• Sound judgement in recognizing when a caller's situation requires escalation to a Care Manager, clinician, or emergency services.
• Ability to work under pressure, manage multiple queries simultaneously, and maintain accuracy and composure in a fast-paced call centre environment.
• Results-oriented, punctual, and committed to meeting service-level agreements (SLAs) and quality assurance standards.

Apply: Call Centre Executive (Clinical) — Careers at ACS

Client Success Executive at Afia Concept Claims Settling Agency

Mid-Level | 2+ years | Nairobi, Kenya | Reports to Senior Care and Provider Relations Lead

Apply for this role | Download JD (PDF)

Applications close on 2 November 2026

Role Purpose

The Client Success Executive is the day-to-day point of contact for assigned clients, responsible for building strong, professional relationships and ensuring every client request, service issue, and complaint is coordinated across ACS's Claims, Medical, Care Management, Provider Relations, and Finance teams and resolved on time.

The role supports client onboarding, monitors service delivery against agreed standards, and gathers client feedback to drive continuous improvement, client satisfaction, and long-term retention.

Key Accountabilities

Client Relationship Management

• Develop and maintain positive and professional relationships with assigned clients.
• Serve as a primary contact for day-to-day client enquiries and service-related matters.
• Build a thorough understanding of client requirements, expectations, and operational needs.
• Conduct regular client engagement and follow-up activities to strengthen relationships.
• Ensure clients receive timely communication and support regarding their requests.
• Foster client confidence through responsive and solution-oriented service.

Client Support & Service Delivery

• Coordinate client requests and ensure prompt action by the relevant departments.
• Monitor service delivery to ensure adherence to agreed service standards and commitments.
• Follow up on outstanding issues to ensure timely resolution.
• Support the implementation of client-specific requirements and initiatives.
• Ensure accurate communication of client needs to internal stakeholders.
• Track service issues and ensure closure within agreed timelines.

Client Onboarding & Account Management

• Support onboarding activities for new clients and members.
• Facilitate collection and maintenance of client information and documentation.
• Assist clients in understanding available services, processes, and support channels.
• Coordinate client account updates, benefit changes, and service notifications.
• Support implementation of new programs, products, and service offerings for clients.

Stakeholder Coordination

• Work closely with Claims, Medical, Care Management, Provider Relations, Finance, Operations, and Customer Experience teams to address client needs.
• Coordinate internal follow-up on client concerns and service matters.
• Facilitate communication between clients and internal stakeholders.
• Escalate complex issues through appropriate channels and monitor progress until resolution.

Complaint & Issue Resolution

• Receive, document, and track client complaints and service concerns.
• Investigate service issues and liaise with relevant departments to obtain resolutions.
• Provide timely updates to clients on the status of ongoing issues.
• Ensure complaints are managed professionally and resolved satisfactorily.
• Identify recurring service issues and recommend corrective actions.
• Maintain records of client feedback, complaints, and resolutions.

Client Engagement & Retention

• Support activities aimed at enhancing client satisfaction and loyalty.
• Participate in client meetings, service reviews, and engagement sessions.
• Gather and document client feedback for continuous improvement purposes.
• Promote positive client experiences through proactive support and communication.

Reporting & Administration

• Maintain accurate records of client interactions, requests, and service activities.
• Prepare routine client service reports and status updates.
• Track open action items and ensure timely follow-up.
• Maintain client files, correspondence, and related documentation.
• Support preparation of presentations, meeting minutes, and engagement materials.
• Ensure proper management of client information and records.

Compliance & Quality Assurance

• Adhere to company policies, procedures, and service standards.
• Ensure confidentiality and proper handling of client information.
• Maintain compliance with contractual and regulatory requirements.
• Contribute to a culture of professionalism, accountability, and customer excellence.

Key Performance Indicators

• Client Satisfaction
• Client Query Resolution
• Complaint Resolution
• Service Delivery Coordination
• Client Retention
• Stakeholder Relationship Management
• Follow-up and Action Closure

Qualifications

• Bachelor's Degree in Business Administration, Marketing, Public Relations, Communications, Insurance, Healthcare Management, or a related field.
• Proficiency in Microsoft Office applications.

Experience

• Minimum of 2 years' experience in client service, account management, customer experience, healthcare administration, insurance, or a related field.
• Experience within healthcare, insurance, managed care, or customer-facing environments will be an added advantage.

Core Competencies

• Client Relationship Management: Ability to build and maintain positive, professional relationships with clients while understanding and responding to their needs effectively.
• Customer Service Excellence: Commitment to delivering high-quality service, ensuring timely responses, issue resolution, and a positive client experience.
• Communication Skills: Strong verbal and written communication skills with the ability to engage clients and internal stakeholders clearly and professionally.
• Stakeholder Coordination: Ability to work collaboratively across departments to ensure efficient service delivery and prompt resolution of client matters.
• Problem-Solving Skills: Ability to identify issues, assess solutions, and coordinate appropriate actions to achieve satisfactory outcomes for clients.
• Professionalism and Integrity: Demonstrates accountability, confidentiality, ethical conduct, and a professional approach in all client and business interactions.

Apply: Client Success Executive — Careers at ACS

Provider Reconciliation Officer at Afia Concept Claims Settling Agency

Mid-Level | 2+ years | Nairobi, Kenya | Reports to Senior Manager - Reconciliations

Apply for this role | Download JD (PDF)

Applications close on 2 November 2026

Role Purpose

The Provider Reconciliation Officer is responsible for ensuring accurate reconciliation of healthcare providers' accounts by validating claims, invoices, payments, recoveries, credit notes, and provider statements. The role plays a critical part in maintaining financial accuracy, supporting timely provider settlements, minimizing disputes, and fostering positive provider relationships.

Within a Third-Party Administration (TPA) environment, the incumbent serves as a key liaison between healthcare providers, claims teams, medical teams, finance teams, and clients to ensure that provider accounts accurately reflect services rendered, approved claims, payments made, and outstanding balances. The role requires strong analytical skills, attention to detail, and a thorough understanding of healthcare claims processing and provider payment cycles.

Key Accountabilities

Provider Account Reconciliation

• Perform regular reconciliation of provider statements against adjudicated claims and payment records.
• Verify the accuracy of provider invoices, statements, remittances, and account balances.
• Match approved claims against payments made to healthcare providers.
• Review provider accounts to identify discrepancies, overpayments, underpayments, duplicate payments, and unallocated transactions.
• Investigate and resolve unidentified or unmatched transactions.
• Maintain accurate reconciliation schedules and supporting documentation.

Claims and Payment Verification

• Validate claims included in provider invoices prior to payment processing.
• Reconcile approved claims against contractual payment schedules and approved tariffs.
• Verify deductions, recoveries, reversals, and adjustments applied to provider accounts.
• Review rejected and partially settled claims and ensure proper documentation.
• Ensure all payment records are accurately reflected in reconciliation reports.
• Collaborate with Claims and Finance teams to address payment variances.

Provider Query and Dispute Resolution

• Respond promptly to provider enquiries relating to invoices, payments, deductions, recoveries, and account balances.
• Investigate provider disputes and reconciliation exceptions.
• Liaise with relevant internal departments to obtain supporting documentation and resolutions.
• Maintain records of provider disputes and resolution actions.
• Follow up on open reconciliation issues until closure.
• Ensure timely communication with providers regarding outstanding matters.

Financial Control and Risk Management

• Identify financial discrepancies and escalate material risks appropriately.
• Monitor ageing balances and unresolved reconciliation items.
• Support recovery of overpayments and identification of duplicate claims.
• Ensure compliance with reconciliation controls and financial procedures.
• Assist in prevention and detection of billing irregularities and fraudulent claims.
• Contribute to initiatives aimed at improving payment accuracy and financial controls.

Provider Relationship Management

• Maintain professional working relationships with healthcare providers.
• Participate in provider engagement meetings where reconciliation issues are discussed.
• Support initiatives aimed at improving provider satisfaction and payment transparency.
• Promote effective communication between providers and internal stakeholders.
• Facilitate resolution of provider concerns through collaborative engagement.

Reporting and Documentation

• Prepare daily, weekly, and monthly reconciliation reports.
• Generate exception reports highlighting unresolved discrepancies.
• Maintain comprehensive reconciliation records and supporting documentation.
• Monitor reconciliation trends and recurring issues.
• Provide reconciliation updates to management as required.
• Support month-end and year-end financial reporting processes.

Process Improvement

• Identify gaps and inefficiencies within reconciliation processes.
• Recommend improvements to enhance reconciliation accuracy and efficiency.
• Participate in process improvement projects and system enhancement initiatives.
• Support implementation of new controls, procedures, and reconciliation tools.
• Contribute to continuous improvement of provider settlement processes.

Compliance and Governance

• Ensure compliance with organizational policies and procedures.
• Adhere to contractual agreements with healthcare providers.
• Maintain confidentiality of provider, client, and member information.
• Support audit exercises by providing reconciliation documentation and reports.
• Ensure compliance with regulatory and industry requirements.
• Promote adherence to ethical and professional standards.

Key Performance Indicators

• Provider Reconciliation Accuracy
• Timeliness of Reconciliation Completion
• Provider Query Resolution
• Outstanding Reconciliation Item Resolution
• Claims and Payment Matching Accuracy
• Provider Dispute Resolution
• Compliance with Reconciliation Procedures
• Accuracy and Timeliness of Reconciliation Reports

Qualifications

• Bachelor's Degree in Accounting, Finance, Business Administration, Economics, Insurance, Health Records, Healthcare Management, or a related field.
• Proficiency in Microsoft Excel and reconciliation systems.

Experience

• Minimum of 2 years' experience in healthcare finance, claims management, provider reconciliation, medical insurance, managed care, or a related field.
• Experience working within a TPA, health insurer, managed care organization, or healthcare administration environment is preferred.

Core Competencies

• Financial and Analytical Skills: Ability to analyze financial records, claims data, invoices, and reconciliation reports with a high degree of accuracy.
• Attention to Detail: Ability to identify discrepancies, inconsistencies, and exceptions while maintaining high levels of accuracy.
• Problem-Solving Skills: Ability to investigate reconciliation issues, identify root causes, and recommend effective solutions.
• Stakeholder Management: Ability to effectively engage providers and internal teams to facilitate issue resolution and service delivery.
• Communication Skills: Strong verbal and written communication skills with the ability to explain reconciliation findings and account variances.
• Professionalism and Integrity: Demonstrates accountability, confidentiality, ethical conduct, and adherence to financial controls.

Apply: Provider Reconciliation Officer — Careers at ACS