• 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

• Bachelor’s Degree in Nursing, Clinical Medicine, or related health field. • 2-4 years’ experience in medical case management in the insurance sector. • Strong clinical knowledge and experience managing medical claims or provider relations. • Excellent communication and decision-making skills. • Ability to work under pressure and coordinate with multiple stakeholders. • Experience in customer, market and competitor understanding. • Knowledge of Insurance regulatory requirements.