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Established in 1937, Jubilee Insurance has grown to become the leading composite insurer in East Africa, offering a wide range of insurance solutions, including Medical Insurance. With a strong foundation in Mombasa, Jubilee Insurance now operates across Kenya, Uganda, Tanzania, and Burundi, serving over 1.9 million clients. As the only ISO-certified insurance group listed on the Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange, and Uganda Securities Exchange, Jubilee Insurance demonstrates a commitment to quality and regional leadership. We are currently seeking a dedicated Care Navigator to join Jubilee Health Insurance Limited at our Head Office in Nairobi, offering an exciting opportunity to guide and support our members through their healthcare journey.
Care Navigator
Job Overview
Location: Nairobi, Kenya (Head Office)
Employment Type: Permanent position.
Deadline: 15th May 2025
💰 Salary: Not provided in the advertisement.
Job Summary
Jubilee Health Insurance Limited is looking for a compassionate and detail-oriented Care Navigator to provide professional guidance to assigned members and schemes on policy matters. The Care Navigator will ensure quality and cost-effective service provision by effectively communicating with providers, clients, and brokers, addressing rejections and relevant concerns in a timely manner, and navigating members towards appropriate healthcare services.
Duties & Responsibilities
- Identify areas for improvement within the care navigation program and proactively propose strategies to enhance its effectiveness and client experience.
- Stay informed about evolving healthcare regulations and policies that may directly affect clients' access to necessary care and benefits.
- Provide valuable input into the development of insurance policies that strategically align with the company's overarching care navigation goals and objectives.
- Analyse crucial data related to healthcare utilization patterns, associated costs, and overall patient outcomes to identify key trends and potential opportunities for program improvement.
- Utilize data-driven insights to inform strategic decision-making processes and drive meaningful enhancements to the care navigation program.
- Monitor the health-seeking behaviours of assigned members and schemes, implementing appropriate and timely measures to positively influence population health outcomes.
- Facilitate the seamless enrolment of eligible scheme members into relevant and beneficial Wellness Programs offered by Jubilee Health Insurance.
- Closely monitor the healthcare utilization patterns of assigned members and schemes, implementing effective control measures to ensure cost-efficiency and quality care.
- Organize and conduct informative health and member education sessions specifically tailored for assigned insurance schemes to promote understanding and engagement.
- Obtain daily reports of admissions for assigned members and schemes across various service providers, proactively organizing and/or conducting visits to admitted members for support and coordination.
- Advise clients effectively on their specific health conditions as necessary, skillfully navigating members towards appropriate service providers who can offer the required level of care.
- Ensure meticulous verification that medical reports shared by healthcare providers are consistently in line with the actual medical management of the patient.
- Ensure the provision of proper care and treatment to patients adheres strictly to acceptable medical protocols and quality standards.
- Interact professionally and effectively with clients, brokers, and clinicians as needed to resolve any problems or issues in a manner that is legal, ethical, and fully consistent with the principles of the insurance policy.
- Thoroughly vet and confirm the validity of services rendered by healthcare providers in relation to the covered benefits, the specific treatment administered, adherence to provider panel rules, and the overall cost of treatment.
- Uphold high ethical standards in all professional interactions with clients, healthcare providers, and internal colleagues, building trust and maintaining integrity.
- Stay informed about all relevant healthcare laws and regulations, including those specifically related to the insurance industry and the protection of client privacy.
- Ensure that all care navigation activities are fully compliant with these evolving healthcare laws and regulations, mitigating potential risks.
- Maintain accurate and complete records of all client interactions and developed care plans, ensuring comprehensive documentation.
- Be transparent with clients regarding the services offered, any potential limitations, and all applicable fees or charges associated with care navigation services.
- Safeguard the strict confidentiality of all client information and consistently adhere to stringent privacy policies and procedures.
- Seek proper authorization in accordance with privacy regulations before disclosing any client-sensitive information to external parties.
- Proactively identify potential risks associated with care navigation activities and collaborate closely with relevant departments to implement effective mitigation strategies.
Key Skills and Competencies
- Healthcare Knowledge: Possess a strong and comprehensive understanding of the healthcare system, including various insurance plans, medical terminology, and relevant healthcare policies and regulations.
- Communication Skills: Exhibit excellent verbal and written communication skills to effectively and professionally interact with clients, healthcare providers, and internal colleagues.
- Empathy and Compassion: Demonstrate the ability to empathize with clients' health concerns and provide compassionate support during potentially difficult and challenging times.
- Active Listening: Possess the crucial skill of actively listening to clients, thoroughly understanding their individual needs, and addressing their concerns with appropriate solutions.
- Problem-Solving Skills: Display strong problem-solving abilities to effectively help clients overcome barriers to accessing care and find suitable solutions to complex healthcare challenges.
- Organization and Time Management: Efficiently manage individual caseloads, appointments, and various care coordination tasks while consistently maintaining a high level of attention to detail.
- Flexibility and Adaptability: Demonstrate the ability to adapt effectively to changing healthcare environments, evolving policies, and the diverse needs of clients.
- Quality Improvement: Exhibit a strong commitment to continuous quality improvement principles and a proactive willingness to participate in initiatives aimed at enhancing care navigation services and client outcomes.
Academic Qualifications
- Degree or Diploma holders in clinical studies (e.g., Nursing, Clinical Medicine, Pharmacy, etc.).
- Basic understanding of the fundamental concepts of insurance.
- Proficient in the use of Microsoft Office Suite and related software packages.
Relevant Experience
- At least three (3) years of relevant professional experience, with a minimum of two (2) years in a Clinical setting.
How to Apply
If you are a qualified and highly motivated individual seeking an exciting new challenge, please submit your application via email to Recruitment@jubileekenya.com. Ensure that you clearly quote the Job Reference Number (JHIL172) and the Position (Care Navigator) in the subject line of your email. The application deadline is 15th May 2025.
📌 Note: Only shortlisted candidates will be contacted for the next steps in the recruitment process.
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