Jubilee Insurance stands as a symbol of excellence and innovation in the East African insurance landscape. Established in August 1937 in Mombasa, Jubilee has steadily grown into the region’s largest composite insurer. The company offers comprehensive insurance solutions across Life, Pensions, General, and Medical Insurance. Jubilee serves over 1.9 million clients and operates offices in Kenya, Uganda, Tanzania, and Burundi.
Distinguished by its ISO certification and listings on three major East African stock exchanges — Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange, and Uganda Securities Exchange — Jubilee continues to set industry benchmarks through operational excellence and customer-centric innovation.
In keeping with its commitment to quality healthcare delivery and strategic growth, Jubilee Health Insurance Limited is currently seeking to recruit a dynamic and results-driven professional for the role of Case Manager, Active Case Management, based at the Head Office in Nairobi.
Position Overview
Job Title: Case Manager, Active Case Management
Job Ref. No: JHIL180
Department: Jubilee Health Insurance Limited
Reporting to: Assistant Manager, Active Case Management
Location: Head Office, Nairobi
Application Deadline: 28th June 2025
This opportunity is tailored for professionals who are clinically adept and possess a solid understanding of medical insurance processes, benefit structures, and regulatory compliance. The Case Manager will play a pivotal role in coordinating hospitalization cases, ensuring the delivery of high-quality, medically appropriate, and financially sustainable care.
Role Purpose
The primary objective of the Case Manager, Active Case Management, is to provide comprehensive clinical oversight and strategic case management for insured individuals requiring inpatient care. The role encompasses pre-authorization evaluations, real-time monitoring of admissions, coordination with healthcare providers, and support for 24-hour service operations.
The successful candidate will ensure alignment with the organization’s care quality standards while managing costs and compliance with policy and regulatory frameworks.
Detailed Job Description
Operational Responsibilities
- Inpatient Pre-Authorizations and Undertakings
Evaluate and authorize inpatient pre-authorization requests based on clinical assessments and policy limits. Ensure swift and accurate decision-making to facilitate timely care. - Medical Documentation Review
Examine submitted medical reports and supporting documents to determine coverage eligibility, clinical necessity, and treatment justification. - 24-Hour Nurse Line Support
Participate in the management and rotation of the nurse line to guarantee uninterrupted access to healthcare support services. - Eligibility Verification and Benefit Analysis
Confirm membership status and scheme-specific entitlements to provide accurate benefit information and treatment coverage decisions. - Inpatient Service Vetting and Authorization
Scrutinize inpatient treatment plans and cost estimates to ensure they are reasonable, necessary, and within benefit limits. - Liaison with Underwriting and Provider Relations
Collaborate across departments to interpret policy documents, resolve ambiguities in benefits, and ensure seamless member servicing. - Stakeholder Communication
Handle inquiries from clients, internal teams, and healthcare providers regarding authorizations, claim statuses, and general policy coverage. - Documentation and Record Keeping
Maintain detailed records of all decisions, transactions, and case progress for future reference, auditing, and continuous improvement. - Turnaround Time and Service Levels
Track and uphold performance metrics related to processing timelines and quality of service delivery, in line with established SLAs and KPIs. - Team Collaboration
Contribute to departmental goals by supporting colleagues, sharing knowledge, and participating in case review discussions.
Corporate Governance Responsibilities
- Policy and Regulatory Adherence
Ensure every claim and pre-authorization is processed in strict conformity with Jubilee’s internal policies and external regulatory requirements. - Decision Documentation
Diligently record the rationale behind case approvals and declines, maintaining consistency, transparency, and accountability. - Undertaking Validation
Validate all submitted requests for completeness, authenticity, and adherence to insurance documentation standards. - Claims Auditing
Perform audits on both inpatient and outpatient claims to identify discrepancies, misuse, or fraudulent patterns. - Treatment and Cost Verification
Confirm the appropriateness of care provided, adherence to provider agreements, and alignment with reasonable cost expectations. - Healthcare Regulation Compliance
Ensure that all case management activities uphold ethical standards and comply with national health laws and professional codes of conduct.
Key Competencies and Skills
- Clinical Competence
A strong foundation in clinical evaluation, allowing accurate interpretation of medical reports and treatment recommendations. - Insurance Policy Acumen
In-depth understanding of health insurance operations, including benefit structures, exclusions, and scheme terms. - Utilization and Case Management Expertise
Proven ability to manage case loads, evaluate medical necessity, and implement cost-effective care strategies. - Analytical and Decision-Making Abilities
Skill in applying policy and clinical criteria to make objective, evidence-based decisions in a timely manner. - Attention to Detail
High levels of accuracy in benefit adjudication, data entry, and documentation of clinical interactions. - Communication and Interpersonal Skills
Excellent verbal and written communication skills, enabling effective interactions with healthcare professionals, members, and internal teams. - Empathy and Professionalism
A compassionate approach to member interactions, paired with unwavering professionalism. - Provider Engagement and Negotiation
Ability to develop and maintain strong working relationships with healthcare providers and negotiate terms aligned with policy guidelines. - Compliance and Ethics Awareness
Strong grasp of regulatory frameworks governing healthcare delivery and medical insurance. - Fraud Detection and Prevention
Aptitude for identifying and mitigating risks related to fraudulent claims, abuse, or billing anomalies.
Required Qualifications
- Bachelor’s degree or diploma in nursing, clinical medicine, or a related healthcare field.
- Valid KRCHN license issued by the Nursing Council of Kenya.
- Relevant certifications in case management, healthcare administration, or clinical specialties are an added advantage.
Relevant Experience
Candidates must have a minimum of two (2) years of hands-on experience in a comparable role within a medical insurance setting. This experience should include:
- Inpatient care coordination
- Insurance benefit administration
- Clinical documentation review
- Policy interpretation
- Pre-authorization processes
Experience in provider engagement and service agreement management will be a valuable addition.
Why Join Jubilee Health Insurance Limited?
This is a unique opportunity to be part of a regionally recognized brand committed to integrity, innovation, and excellence in health insurance services. The successful candidate will gain:
- Exposure to industry-leading practices in clinical case management
- Opportunities for professional development and training
- A collaborative working environment with supportive leadership
- The ability to contribute to the health outcomes of a diverse insured population
How to Apply
If you are qualified and enthusiastic about contributing to a company that is shaping the future of health insurance in East Africa, we invite you to submit your application.
Please send your application via email to:
[email protected]
Quote the Job Reference Number JHIL180 and Position Title: Case Manager, Active Case Management in the subject line.
Deadline for application submission: 28th June 2025
Only shortlisted candidates will be contacted. Ensure that your CV is updated and clearly outlines your experience relevant to this role.
Join Jubilee Health Insurance Limited and be part of a team that values expertise, collaboration, and client-centered healthcare solutions.
