Case Management Officer (Medical)
2025-07-24T08:47:51+00:00
Britam Insurance Company Uganda Limited
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FULL_TIME
kampala
Kampala
00256
Uganda
Insurance
Healthcare
2025-08-02T17:00:00+00:00
Uganda
8
Job Purpose:
To oversee and coordinate all pre-authorization, admission, discharge, and care coordination activities, ensuring quality patient care while managing medical costs and provider relationships effectively.
Key Responsibilities:
- Oversee medical case management and pre-authorizations
- Ensure timely and appropriate approvals for inpatient and outpatient services.
- Collaborate with hospitals, TPAs, and providers to ensure quality care delivery.
- Monitor and track high-cost cases, chronic illnesses, and frequent claimants.
- Offer clinical guidance to underwriters and claims analysts on complex cases.
- Train and mentor staff and ensure process adherence.
- Maintain and update provider tariff lists and treatment protocols.
- Support fraud detection and provider performance reviews.
- Stay updated on industry trends, emerging risks, regulatory changes, and new technologies that could affect underwriting practices.
- Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard.
- Perform any other duties as may be assigned from time to time
Knowledge, experience and qualifications required
1. Bachelor’s Degree in Nursing, Clinical Medicine, or related health field.
2. 2-4 years’ experience in medical case management in the insurance sector.
3. Strong clinical knowledge and experience managing medical claims or provider relations.
4. Excellent communication and decision-making skills.
5. Ability to work under pressure and coordinate with multiple stakeholders.
6. Experience in customer, market and competitor understanding.
7. Knowledge of Insurance regulatory requirements.
Oversee medical case management and pre-authorizations Ensure timely and appropriate approvals for inpatient and outpatient services. Collaborate with hospitals, TPAs, and providers to ensure quality care delivery. Monitor and track high-cost cases, chronic illnesses, and frequent claimants. Offer clinical guidance to underwriters and claims analysts on complex cases. Train and mentor staff and ensure process adherence. Maintain and update provider tariff lists and treatment protocols. Support fraud detection and provider performance reviews. Stay updated on industry trends, emerging risks, regulatory changes, and new technologies that could affect underwriting practices. Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard. Perform any other duties as may be assigned from time to time
1. Bachelor’s Degree in Nursing, Clinical Medicine, or related health field. 2. 2-4 years’ experience in medical case management in the insurance sector. 3. Strong clinical knowledge and experience managing medical claims or provider relations. 4. Excellent communication and decision-making skills. 5. Ability to work under pressure and coordinate with multiple stakeholders. 6. Experience in customer, market and competitor understanding. 7. Knowledge of Insurance regulatory requirements.
JOB-6881f33757417
Vacancy title:
Case Management Officer (Medical)
[Type: FULL_TIME, Industry: Insurance, Category: Healthcare]
Jobs at:
Britam Insurance Company Uganda Limited
Deadline of this Job:
Saturday, August 2 2025
Duty Station:
kampala | Kampala | Uganda
Summary
Date Posted: Thursday, July 24 2025, Base Salary: Not Disclosed
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JOB DETAILS:
Job Purpose:
To oversee and coordinate all pre-authorization, admission, discharge, and care coordination activities, ensuring quality patient care while managing medical costs and provider relationships effectively.
Key Responsibilities:
- Oversee medical case management and pre-authorizations
- Ensure timely and appropriate approvals for inpatient and outpatient services.
- Collaborate with hospitals, TPAs, and providers to ensure quality care delivery.
- Monitor and track high-cost cases, chronic illnesses, and frequent claimants.
- Offer clinical guidance to underwriters and claims analysts on complex cases.
- Train and mentor staff and ensure process adherence.
- Maintain and update provider tariff lists and treatment protocols.
- Support fraud detection and provider performance reviews.
- Stay updated on industry trends, emerging risks, regulatory changes, and new technologies that could affect underwriting practices.
- Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard.
- Perform any other duties as may be assigned from time to time
Knowledge, experience and qualifications required
1. Bachelor’s Degree in Nursing, Clinical Medicine, or related health field.
2. 2-4 years’ experience in medical case management in the insurance sector.
3. Strong clinical knowledge and experience managing medical claims or provider relations.
4. Excellent communication and decision-making skills.
5. Ability to work under pressure and coordinate with multiple stakeholders.
6. Experience in customer, market and competitor understanding.
7. Knowledge of Insurance regulatory requirements.
Work Hours: 8
Experience in Months: 24
Level of Education: bachelor degree
Job application procedure
Interested and qualified? Click here to apply
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