Jubilee Insurance was established in August 1937 as the first locally incorporated insurance company based in Mombasa. Over the years, we have grown to become the largest composite insurer in East Africa, offering Life, Pensions, General, and Medical Insurance. With a client base exceeding 1.9 million, Jubilee is the number one insurer in East Africa. We operate in Kenya, Uganda, Tanzania, and Burundi and are the only ISO-certified insurance group listed on the three East African stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange, and Uganda Securities Exchange.
For more information, visit www.JubileeInsurance.com.
We are currently seeking a Third-Party Administrator (TPA) to join our team at Jubilee Health Insurance Limited. The position holder will report to the Deputy General Manager, Operations, and will be based at our Head Office in Nairobi.
Role Purpose
The Third-Party Fund Administrator (TPA) will be responsible for managing and administering funded medical schemes. The role ensures the efficient allocation and reporting of funds while maintaining strong relationships with clients and healthcare providers. Additionally, the role involves underwriting processes to mitigate risks and ensure compliance with regulatory requirements.
Key Responsibilities
1. Strategy Development
- Develop and implement strategies to optimize the utilization of medical insurance funds.
- Forecast fund requirements based on claims trends, risk assessments, and actuarial insights.
- Collaborate with underwriting and actuarial teams to design pricing models and policies aligning with strategic objectives.
- Identify potential risks related to fund mismanagement, fraud, or over-utilization and propose mitigation strategies.
- Provide insights on industry trends and emerging practices in fund administration to enhance competitive advantage.
- Align fund management strategies with client needs, company objectives, and regulatory frameworks.
- Strengthen relationships with key stakeholders, including insurers, healthcare providers, and corporate clients.
2. Operational Management
- Manage fund utilization and monitor balances to avoid shortfalls or overages.
- Ensure timely collection of replenishments and deposits into client fund accounts.
- Process medical claims within agreed timelines and ensure accurate reconciliation with allocated funds.
- Review, process, and approve claims based on set policies and procedures.
- Prepare and present detailed fund utilization and performance reports for internal and external stakeholders.
- Address disputes or discrepancies in claims or fund balances, ensuring prompt resolution.
- Identify and implement process improvements to enhance fund administration operations.
- Utilize data analytics tools to track fund performance and streamline decision-making processes.
3. Corporate Governance & Compliance
- Ensure all fund administration activities comply with local laws, company policies, and industry regulations.
- Maintain strict confidentiality and data privacy for all financial transactions and client records.
- Conduct regular fund audits and implement internal controls to ensure transparency and accountability.
- Prepare for and manage external audits, providing necessary documentation and explanations.
- Develop and enforce policies and guidelines for fund management and underwriting operations.
- Ensure all stakeholders adhere to corporate governance standards in fund administration processes.
4. Leadership & Relationship Management
- Build and maintain strong relationships with healthcare providers, corporate clients, and insurers.
- Act as the primary contact for TPA clients, resolving issues and ensuring high satisfaction levels.
- Regularly engage with clients and partners to understand their needs and improve service delivery.
Key Skills and Competencies
- Expertise in managing, allocating, and reconciling funds for medical underwriting and claims.
- Proficient in tracking fund utilization and ensuring adherence to agreed limits.
- In-depth understanding of medical insurance underwriting principles, risk assessment, and pricing strategies.
- Ability to evaluate medical claims and align them with underwriting policies.
- Strong analytical skills for tracking fund performance, utilization trends, and identifying anomalies.
- Skilled in verifying and approving medical claims based on policy terms and fund availability.
- Effective at coordinating with insurers, healthcare providers, clients, and internal teams to address fund-related inquiries.
- Strong understanding of regulatory frameworks governing fund administration and medical underwriting.
- Experience in implementing measures to ensure compliance and mitigate risks, including fraud detection.
- Ability to identify inefficiencies in fund management and claims processing and recommend improvements.
- Skilled in creating and maintaining fund administration policies that align with organizational and regulatory standards.
Academic & Professional Qualifications
- Bachelor’s degree in Actuarial Science or a Business-related field.
- Mandatory Insurance Professional Qualification.
- Proficiency in Microsoft Office Suite.
Relevant Experience
- Minimum of 3 years’ experience in fund administration, medical underwriting, or similar roles within the insurance industry.
- Proven experience managing large-scale funds, claims, and stakeholder relationships.
- Familiarity with Third Party Administration (TPA) services, including claims processing, provider network management, and client onboarding.
How to Apply
If you are qualified and looking for an exciting career opportunity, please apply via [email protected] quoting the Job Reference Number and Position by 14th March 2025.
Only shortlisted candidates will be contacted
