– Diploma or Bachelor’s Degree in Nursing, Clinical Medicine, Pharmacy, or related medical field
– Professional qualifications in insurance (e.g., COP, AIIK, CII) will be an added advantage
– Registration and valid practicing license with a recognized professional body (e.g., Nursing Council of Kenya, Clinical Officers Council, Pharmacy and Poisons Board)
- Experience in preauthorization processes
- Cost containment
- Provider negotiations
- Familiarity with claims management systems
- MS Office tools
- Coordinate and oversee the preauthorization process for inpatient and outpatient
- Ensure compliance with policy terms
- Ensure quality healthcare delivery
- Ensure timely decisions
- Ensure cost-effective outcomes for members