JOB PROFILE

The Director, Provider and Beneficiary Management, will provide strategic leadership in managing provider networks and beneficiary services within the Social Health Authority (SHA). This role is responsible for for conducting Beneficiary’s satisfaction surveys and undertake other diagnostic studies, Support adherence and public awareness on referral guidelines and Empanelment of healthcare providers and ensure they are operating in line within the set industry and professional standards.

QUALIFICATIONS

Applicants must meet the following minimum requirements as stipulated under the SHI Act, 2023:

1. Be a Kenyan citizen.

2. Hold a bachelor’s degree in commerce, Accounting, Business Administration, Finance, Economics, Business, Medicine, Social Science, Pharmacy, or an equivalent qualification from a recognized institution.

3. Hold a master’s degree in any of the following fields: Strategic Management, Finance, Business Administration, or an equivalent qualification from a recognized institution.

4. Have at least fifteen (15) years cumulative experience, five (5) of which must be at a senior management level or a comparable position in the public or private sector.

5. Leadership Course lasting not less than four (4) weeks from a recognized institution.

6. Member of a relevant professional body.

7. A valid practicing license from the relevant body.

8. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

9. Proficiency in computer applications

10. Meet the requirements of Chapter Six of the Constitution of Kenya

KEY COMPETENCIES

1. Strategic Leadership and Governance

2. Stakeholder Engagement and Communication Skills

3. Financial and Risk Management Expertise

4. ICT Proficiency and Data-Driven Decision Making

5. Strong Ethical Practices and Good Governance

6. Ability to Foster Innovation and Institutional Growth

The Director, Provider and Beneficiary Administration shall:

1. Provide timely and accurate advice to the Chief Executive Officer on the performance of provider and beneficiary management operations, ensuring alignment with the Authority’s strategic goals, digital transformation objectives, and budgetary priorities.

2. Enforcement of compliance with SHI ACT, related legislation and policies on matters pertaining to beneficiary and provider management.

3. Development, implementation, monitoring and reviewing of sustainable operational strategies relating to beneficiary, provider and stakeholders’ management.

4. Liaising with Strategy and Planning function in the development, implementation and review of SHA policies relating to beneficiary, provider and stakeholders’ management.

5. Engagement with the stakeholders in the Public, Private and Sponsored Programs Sectors towards attainment of Universal Health Coverage.

6. stakeholder engagement activities to enhance the achievement of set targets in beneficiary, provider and stakeholders’ management.

7. Provision of technical advice to the CEO and Board of Management on issues pertaining to beneficiary, provider and stakeholders’ management.

8. Development and implementation of strategies and policies to enhance beneficiary, provider and stakeholders management.

9. Production and dissemination of all monitoring and evaluation reports including statistical reports.

10. Development and implement strategies for enhancing increased geographical access to healthcare services.

11. implementation of quality improvement strategies and policies in empaneled health care facilities.

12. Resolution of complaints from both Beneficiaries and Providers.

13. Production and dissemination of all monitoring and evaluation reports including statistical reports for beneficiary and Provider Management.

14. Establish, maintain and update quality assurance systems in accordance with International Best Practices.

JOB PROFILE

The Director, Benefits & Claims Management, will oversee the operations of the Social Health Authority (SHA) in the administration and management of benefits and claims. This pivotal role is responsible for providing strategic leadership, direction, and coordination to ensure the efficient and effective delivery of benefits and claims services in alignment with the provisions of the Social Health Insurance Act, 2023. The position is central to ensuring the Authority’s benefits and claims management strategies are aligned with its overall goals, enhancing operational efficiency, statutory compliance, and quality-of-service delivery to members and stakeholders.

QUALIFICATIONS

Applicants must meet the following minimum requirements as stipulated under the SHI Act, 2023:

1. Be a Kenyan citizen.

2. Fifteen (15) years cumulative experience, five (5) of which must have been at a senior management level or a comparable position in the public or private sector.

3.  Bachelor’s degree in Medicine and Surgery, Health Financing, Health Economics, Pharmacy, Actuarial Sciences, Dentistry, Statistics, Mathematics, from a recognized institution. 

4. Master’s degree in Medicine and Surgery, Business Administration, Public Health, Health System Management, Health Economics, Health Financing, Statistics, Mathematics, or equivalent from a recognized institution. 

5. Leadership course lasting not less than four (4) weeks from a recognized institution.

6. Membership to the relevant professional body in good standing.

7. Valid Practicing license.

8. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

9. Meet the requirements of Chapter Six of the Constitution of Kenya

KEY COMPETENCIES

1. Strategic Leadership and Governance.

2. Stakeholder Engagement and Communication Skills.

3. Strong Ethical Practices and Good Governance.

4. Ability to Foster Innovation and Institutional Growth.

The Director, Benefits & Claims Management shall:

1. Ensure strategic and operational planning for Health Benefits and medical claims management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.

2.  Ensure Formulation and implementation of policies and strategies for effective and efficient Medical claims and Health Benefits management in collaboration with other departments.

3. Oversee the strategic purchasing of benefit packages in close collaboration with the Directorate of Fund Management, ensuring efficiency, equity, and cost-effectiveness in service delivery.

4. Oversee reviewing, processing and validating medical claims from healthcare providers and healthcare facilities;

5. Oversee issuing of pre-authorizations, appraising medical claims, quality assurance surveillance and claims adjudication based on the benefit package for access to healthcare services;

6. Coordinate establishment of systems and controls for detecting and identifying fraud appropriate to the Authority’s exposure and vulnerability in collaboration with other Departments. 

7. Oversee Sensitization of claimants on the consequences of submitting false and fraudulent claims;

8. Ensure effective collection and analyzing of data for purposes of claim management in collaboration with other departments. 

9. Coordinate collaborations with relevant entities in the Health Needs Assessment for clinical interventions and other technologies;

10. Oversee preparation of reports on Health Benefits and Medical Claims.

11. Oversee effective implementation and continuous improvement of Benefits and Claims management information systems, ensuring they support efficient operations and member satisfaction in collaboration with other departments. 

12. Ensure robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders.

13. Ensure compliance with local and international standards in Benefits and Claims Management (as prescribed in the Act), fostering alignment with globally recognized best practices and enhancing the Authority’s reputation. 

14. Ensure the development and execution of policies and strategies for business process re-engineering, driving innovation and efficiency in Benefits and Claims Management.

15. Provide expert guidance on reviewing and amending the Social Health Insurance Act, ensuring responsiveness to the evolving healthcare landscape and adherence to quality standards.

JOB PROFILE

The Director, Funds & Finance Management will oversee the operations of the Social Health Authority (SHA) in Funds and Financial Management. This pivotal role is responsible for providing strategic leadership, direction, and coordination to ensure the effective management of financial resources in alignment with the provisions of the Social Health Insurance Act, 2023. The position is central to ensuring the Authority’s financial strategies and operations are aligned with its overall goals, driving operational efficiency, statutory compliance, and enhanced service delivery.

QUALIFICATIONS

Applicants must meet the following minimum requirements as stipulated under the SHI Act, 2023:

1. Be a Kenyan citizen.

2. Fifteen (15) years’ cumulative experience, five (5) of which should have been at senior management level or in a comparable position in the public or private sector. 

3. Bachelor’s degree in any of the following fields: - Business, Economics, Social Science, or any other related field from a recognized institution;

4. Master’s degree in any of the following fields Medicine, Business, Economics, Pharmacy, Social Science.

5. Certified Public Accountant (CPA)K by Kenya Accountants and Secretaries Examination Board (KASNEB) or any other relevant qualification from a recognized institution;

6. Be a registered member of a relevant professional body

7. Leadership certificate course lasting not less than four (4) weeks at a recognized institution.

8. Proficiency in computer applications

9. Fulfill the requirements of chapter six (6) of the constitution

KEY COMPETENCIES

1. Strong analytical and reporting skills

2. Ability to interpret long term plans, programs and budgets

3. Project management skills

4. Ability to develop plans, programs, SOPS, and coordination of workflows

5. Strategic management skills

6. Strong leadership and communication skills

7. Decision making

The Director, Funds & Finance Management shall:

1. Provide timely and accurate advice to the Chief Executive Officer on the performance of Funds & Finance Management in relation to the Authority’s strategic plan and budget.

2. Ensuring the establishment of a pool for receiving and payment of funds for Primary Health Care services, Social Health Insurance Services, Emergency Services, Chronic Diseases Services, Critical Illness services and medical schemes for the Public sector.

3. Overseeing the resource mobilization of funds for PHCF, SHIF ECCF from appropriation by the National Assembly, household contributions, grants, donations, Fees, levies and gift in collaboration with other entities.

4. Ensuring funds are received from the respective sources for provision of Primary Health Care services, Social Health Insurance Services, Emergency Services, Chronic Disease Services, Critical Illness services in the country.

5. Overseeing the Strategic Purchasing of PHC, SHI ECC Health Care services from contracted and empanelled health facilities as specified in the benefit package in collaboration with other directors.

6. Ensuring the verification of claims received from claims management office for PHCF services, SHIF ECCF services based on the prescribed tariffs, verified claims and benefit package.

7. Overseeing the payment of health providers and health facilities for the provision of quality PHC, SHI, and ECC health services based on the prescribed tariffs, verified claims and benefit package.

8. Lead the development and review of guidelines for the operations of the PHCF, SHIF, and ECCF.

9. Ensuring the preparation of annual financial statements for PHCF, SHIF, ECCF and Public service Fund.

10. Overseeing the submission of financial statements for PHCF, SHIF, and ECCF to the relevant agencies.

11. Coordinating the planning and budgeting process for PHCF, SHIF, and ECCF finances.

12. Participating in stakeholder engagement for the PHCF, SHIF, and ECCF.

13. Identifying resource gaps and recommend priority areas for PHC, SHI, and ECC services.

14. Lobbying for allocation of adequate funds for PHC, SHIF, and ECC services by the exchequer.

15. Ensuring the maintenance of books of accounts on all transactions related to the PHCF, SHIF, and ECCF.

16. Ensuring the preparation of periodic reports on operations and performance of the PHCF, SHIF, and ECCF.

17. Collaborating with other directors and relevant government agencies on capacity building and stakeholder engagement for PHCF, SHIF, and ECCF.

18. Develop guidelines to integrate the medical scheme benefits with the Social Health Insurance Act, ensuring seamless service delivery for public officers.

19. Ensure compliance with statutory and regulatory requirements, including payroll deductions and fund utilization.

20. Coordinate with the Social Health Authority to monitor the exhaustion of social health insurance benefits before activating the Public Officers Medical Scheme.

21. Engage with service providers, including hospitals and insurers, to ensure efficient delivery of health services under the Scheme.

22. Develop mechanisms to track and report on fund inflows and outflows to ensure transparency and accountability.

23. Monitor the recovery of medical benefits funds and ensure timely disbursement to the Scheme.

24. Evaluate the utilization of funds and the impact of the Scheme on public officers’ healthcare access and outcomes.

25. Provide periodic reports and recommendations to the State Department for Public Service for policy and operational improvements.

26. Conduct capacity-building initiatives for staff managing the Fund to enhance operational efficiency.

27. Ensure continuous professional development of team members to keep abreast of healthcare financing trends.

28. Identify and mitigate risks related to fund management, contribution recovery, and service delivery under the Scheme.

29. Ensure adherence to procurement and financial management laws in fund operations.

30. Leverage data insights to improve service delivery and optimize fund utilization.

31. Coordinate with the Social Health Authority for integrated data sharing and reporting.

32. Ensure timely resolution of issues to enhance member satisfaction and trust in the Scheme.

33. Develop long-term strategies to expand coverage and improve benefits under the Public Officers Medical Scheme

JOB PROFILE

The Director, Corporate Services, will oversee the operations of the Social Health Authority (SHA) in Human Resource Management, Administration, Corporate Communication and Information Technology Communication. This pivotal role is responsible for providing strategic leadership, direction, and coordination to ensure the seamless delivery of corporate support services in line with the provisions of the Social Health Insurance Act, 2023. The position plays a key role in integrating the Authority’s human resources and administrative functions with its strategic goals to drive operational efficiency, ensure compliance with statutory requirements, and enhance overall service delivery.

QUALIFICATIONS

Applicants must meet the following minimum requirements as stipulated under the SHI Act, 2023:

1. Be a Kenyan citizen.

2. Have at least fifteen (15) years cumulative experience, five (5) of which must be at a senior management level or a comparable position in the public or private sector.

3. Bachelor’s degree in any of the following Human Resource Management, Social Science, Business, Economics, Administration or an equivalent qualification from a recognized institution 

4. Master’s degree in any of the following Human Resource Management, Social Science, Business, Economics, Administration or an equivalent qualification from a recognized institution 

5. Membership to a professional body where applicable.

6. Leadership course lasting not less than four (4) weeks from a recognized institution;

7. Demonstrated merit and ability as reflected in work performance and results

KEY COMPETENCIES

1. Strategic Leadership and Governance.

2. Stakeholder Engagement and Communication Skills.

3. Knowledge in Financial and Risk Management.

4. ICT Proficiency.

5. Strong Ethical Practices and Good Governance.

6. Ability to Foster Innovation and Institutional Growth.

The Director, Corporate Services shall:

1. Provide timely and accurate advice to the Chief Executive Officer on the performance of Human Resources, Administration, Corporate Communication and Information Technology Communication Services in relation to the Authority’s strategic plan and budget.

2. Lead the development and implementation of strategic and operational plans for the Human Resources, Administration, Corporate Communication and Information Technology Communication departments, ensuring alignment with the Authority’s overall goals and objectives, by Establishing performance measurement systems to promote accountability and track success.

3. Design and implement best-practice human resource strategies and programs to maximize individual and organizational capability, by Building a sustainable, positive workforce environment and culture within the Authority.

4. Actively promote a culture of continuous improvement and business excellence, recognizing achievements and fostering innovation.

5. Regularly review and update Human Resource & Administration, Corporate Communication and Information Technology Communication policies and procedures to ensure compliance with statutory regulations governing Human Resources and Administration, Corporate Communication and Information Technology Communication operations.

6. Oversee the security and safety of the Authority’s premises and properties; 

7. Management of the Authority’s transport and logistics

8. Oversee all implementation of all outsourced services and implementation of leases.

9. Ensure proper management of the Authority’s property and asset to maximize their economic values

10. Oversee the development and implementation of strategic procurement plans, ensuring transparent and efficient processes for acquiring capital equipment, goods, and services in line with the annual budget.

11. Developing communication strategies for SHA;

12. Overseeing general protocol at SHA;

13. Implement the SHA Customer Experience   Charter.

JOB PROFILE

The Director, Internal Audit, will oversee the operations of the Internal Audit function within the Authority, by assessing and giving recommendations on the effectiveness of internal controls, risk management, and governance processes. This role is responsible for providing strategic leadership, direction, and coordination of the internal audit function in line with the provisions of the Social Health Insurance Act, 2023. The position plays a key role in integrating the Authority’s audit functions with its strategic goals to drive operational effectiveness, ensure compliance with statutory and regulatory frameworks, and enhance the reliability and integrity of the organization’s operations.

Applicants must meet the following minimum requirements as stipulated under the SHI Act, 2023:

1. Be a Kenyan citizen.

2. At least 15 years cumulative experience, five (5) of which should have been at senior management level or in a comparable position in the public or private sector. 

3. Master’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Auditing, Business Administration or its equivalent qualification from a recognized institution;

4. Bachelor’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Business Administration or its equivalent qualification from a recognized institution; 

5.  Leadership Course lasting not less than four (4) weeks from a recognized institution; 

6. Be a registered member of the relevant professional body;

7. Fulfill the requirements of Chapter Six of the constitution;

8. Proficiency in Computer application; and

9. Demonstrated merit and ability as reflected in work performance and results.  

KEY COMPETENCIES

1. Strong analytical skills

2. Communication skills

3. Strong interpersonal skills

4. Negotiation skills

The Director, Internal Audit shall:

1. Formulate, seek approval by the Board and coordinate the implementation of internal audit directorate policies, strategies and procedures

2. Harmonize and align the internal audit directorate’s functions with the strategic objectives of the Authority

3. Prepare and seek approval of the Annual Audit Plan by the Board Audit Committee and ensure effective implementation of the approved plan

4. Provide secretarial services to the Audit Committee of the Board, ensuring effective communication of audit findings and recommendations.

5. Report audit findings to Management and the Board’s Audit Committee, ensuring transparency and adherence to the SHI Act 2023’s reporting requirements.

6. Advise the Board, Senior Management and the CEO on emerging trends and developments affecting internal controls, governance and risk management, and proactively recommend corrective actions and improvements. 

7. Oversee the implementation of audit recommendations (both internal and external), tracking progress and reporting updates to Senior Management and the Audit Committee to ensure continuous improvement in operational controls.

8. Foster effective collaboration with the Board Audit Committee, staff, external auditors, relevant government agencies, and other stakeholders, ensuring all audit processes are in line with the SHI Act 2023.

9. Review and evaluate the progress made towards achieving the strategic plan objectives and performance targets, reporting findings to the CEO and Senior management, with actionable insights for improvement.

10. Provide timely and accurate advice to the Chief Executive Officer on the performance of internal audit functions in alignment with the Authority’s strategic goals, operational plans, and budget, ensuring compliance with the Social Health Insurance Act, 2023.

11. Coordinate the activities of external auditors and other assurance providers geared towards improving operations of the Authority. 

12. Ensure performance targets are set and performance assessment undertaken for staff within the directorate.

JOB PROFILE

The Deputy Director, County Coordination, will provide strategic leadership and oversight of the Social Health Authority’s (SHA) operations at the county level. This role ensures effective management of county resources, operational efficiency, and statutory compliance in alignment with the Social Health Insurance Act, 2023. The position is key in driving service delivery, optimizing resource utilization, and ensuring SHA’s county strategies align with its national objectives.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience and at least three (3) of which should have been at the level of Assistant Director or in a comparable position in the public or private sector 

2. Bachelor’s degree in commerce, Accounting, Business Administration, Finance or Economics, Business, Medicine, Social Science, Pharmacy or equivalent qualification from a recognized institution.

3. Master’s Degree in any of the following: Strategic Management, Finance, Business Administration or equivalent qualification from a recognized institution.

4. Member of the relevant professional body;

5. Management course lasting not less than four weeks;

6. Proficiency in computer applications;

7. Meet the requirement of chapter 6 of the Constitution of Kenya.

Key Competencies and Skills

1. Reporting skills;

2. Analytical skills;

3. Good Communication skills;

4. Good Interpersonal skills; and

5. Good Organizational skills

1. 1. Provide strategic leadership and direction to regional operations to achieve organizational goals.

   2. Develop and oversee regional strategies for optimal customer experience, service delivery, and compliance with SHA policies.

   3. Lead the execution of the customer service   strategy, ensuring alignment with the organizational vision and objectives.

   4. Establish and maintain effective stakeholder relationships to enhance service delivery and promote SHA programs.

   5. Oversee regional performance management, including target setting, reviews, and reporting, to drive accountability and results.

   6. Ensure the effective implementation of quality assurance programs and operational standards across all branches.

   7. Provide strategic oversight for regional recruitment, registration, and compliance activities, ensuring strong membership growth.

   8. Monitor benefit administration, utilization, and provider contract enforcement within the region.

   9. Develop and execute strategies for fraud mitigation, prevention, and resolution of regional complaints.

   10. Lead market research and business intelligence efforts to identify opportunities for improvement and innovation.

   Advise the CEO on models for efficient service delivery and propose enhancements based on regional insights.

JOB PROFILE

The Deputy Director, Human Resource Management & Development will provide strategic leadership in human capital management to ensure an efficient, motivated, and performance-driven workforce within the Social Health Authority (SHA). This role is responsible for developing and implementing HR policies, talent acquisition, performance management, staff welfare, training and capacity building, and succession planning in line with the Social Health Insurance Act, 2023 and other relevant regulations. The position also ensures compliance with labor laws, fosters a positive workplace culture, and aligns HR strategies with SHA’s overall objectives.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which should have been at the level of assistant director or in a comparable position in the public or private sector.

2. Bachelor’s degree in any of the following disciplines: -, Human Resource Management or equivalent qualifications from a recognized institution.

3. Master’s degree in any of the following disciplines: - Human Resource Management, Administration, Business Administration, qualifications or equivalent qualification from recognized institution.

4. Postgraduate/Higher Diploma in Human Resource or Certified Human Resource Practitioners or Equivalent qualifications

5. Member of a professional body in good standing

6. Management course lasting not less than four (4) weeks at a recognized institution.

7. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

8. Fulfil the requirements of Chapter Six of the Constitution of Kenya.

Key Competencies and Skills

1. Ability to think strategically and innovatively

2. Proven intellectual leadership in managing people and financial resources

3. Excellent interpersonal, management and communication skills

4. Excellent organizational skills and highly confident

5. Computer literacy and familiarity with standard office computer applications

6. Ability to mobilize resources

7. Negotiation skills

1. Provide professional leadership in the development and implementation of human resources plans and budgets, outlining activities to be undertaken, resource requirements, key performance measures and indicators as well as expected outcomes

2. Conduct workforce analysis, determine optimum staff requirements and design organizational structure that maximizes synergies across functions to support the implementation of the SHA strategic plan

3. Analyze organizational structures, business processes and workplace relationships in order to eliminate hierarchical layers and strengthen opportunities for increased collaboration through flexible work teams

4. Conduct job analysis in order to develop Job Specifications and competency profiles to facilitate human capital planning, staff recruitment and selection, performance management, training and development, job evaluation and pay structure design as well as career planning

5. Coordinate the recruitment and selection process in order to ensure that SHA has a critical mass of qualified human resources with the required competencies necessary for implementation of departments strategic management plans

6. Develop and coordinate the implementation of staff induction and on the job orientation programmes aimed at providing new staff with relevant information about the technical and social aspects of their work

7. Assess training needs analysis and baseline attitude surveys in order to design and implement relevant training programmes aimed at building capacity by equipping staff with the necessary knowledge, skills and behavior characteristics in line with the strategic plan

8. Coordinate the implementation of the performance management system and ensure that individual and team performance is continuously monitored and measured against realistic but challenging targets aligned to the strategic direction by clearly defining performance measures and indicators, expected timeframe as well as resource requirements.

9. Oversee the implementation of an effective human resource management information system for monitoring, tracking and evaluating employee activities including staff training, performance management, medical, pension and welfare programmes

10. Oversee proper maintenance, storage and security of officers records to ensure integrity of data and information related to human resource development programmes

11. Coordinate resolution of employee grievances and disciplinary cases, recommending appropriate action to resolve problems as well as assisting employees to find satisfactory solutions to personal problems through counseling services

12. Administer provision of employee medical and insurance packages including workers’ compensation through the appropriate benefit schemes such as SHAand other employee welfare programmes

13. Develop and implement human resource policies and procedures aimed at enhancing workplace relations in order to gain employee commitment and improve morale by ensuring that employees are treated fairly, uniformly and equitably

14. Confer with relevant professional bodies and government agencies on the interpretation and application of particular human resource management regulations that apply to a public sector organization

15. Developing, implementing and evaluating staff career and succession plans, and development to ensure staff attraction, retention, motivation and job satisfaction.

JOB PROFILE

The Deputy Director, Administration, will provide strategic leadership in administrative services to ensure efficient operations and optimal resource utilization within the Social Health Authority (SHA). This role oversees office administration, facilities management, transport and logistics, records management, and general support services. The position is responsible for developing and implementing administrative policies, enhancing operational efficiency, and ensuring compliance with regulatory requirements. Additionally, the role supports business continuity, security management, and the alignment of administrative functions with SHA’s overall objectives.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which should have been at the level of assistant director or in a comparable position in the public or private sector.

2. Bachelor’s degree in social sciences or administration/management from a recognized institution;

3. Master’s degree in social sciences or administration/management from a recognized institution;

4. Membership to a professional body where applicable

5. Management course lasting not less than four (4) weeks at a recognized institution.

6. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

7. Meet the requirements of Chapter Six of the Constitution of Kenya

Key Competencies and Skills

1. Operational problem-solving skills

2. Ability to develop long term integrated and cross functional operational plans

3. Ability to operationalize strategy into action for the organization as whole

4. Strong leadership and management skills

5. Strong Negotiation skills 

6. Ability to drive change and innovation 

7. Strong analytical and interpretative skills

JOB PROFILE

The Deputy Director, Legal Services will provide strategic legal leadership and guidance to ensure the Social Health Authority (SHA) operates within the legal and regulatory framework of the Social Health Insurance Act, 2023, and other relevant laws. This role oversees legal compliance, contract management, dispute resolution, policy formulation, and governance matter to safeguard the Authority’s interests. Additionally, the position ensures adherence to statutory obligations, mitigates legal risks, and supports decision-making through sound legal advice.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience and at least three (3) of which should have been at the level of Assistant Director or in a comparable position in the public or private sector 

2. Bachelor of Laws degree from a recognized institution;

3.  Master’s Degree in Law or a relevant field from a recognized institution

4. Postgraduate Diploma in Law from the Kenya School of Law;

5. Admitted as an Advocate of the High Court of Kenya;

6. Hold a valid practicing certificate;

7. Member of the Law Society of Kenya;

8. Leadership course lasting not less than four (4) weeks at a recognized institution.

9. Demonstrated merit and ability as reflected in work performance and results; and

10. Fulfilled the requirements of Chapter Six of the Constitution.

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strategic and innovative thinking

4. Strong interpersonal skills

5. Ability to mobilize resources

6. Negotiation skills

1. Conduct Legal Due Diligence on all prospective Lessees, Licensees, Partners or other third parties with whom the Authority is to enter a legal relationship with.

2. Developing and vetting policy papers and instruments with legal implications for approval by the Authority;

3. Advising the Authority and coordination with the functional areas in relation to various legal requirements which must be complied with and the legal obstacles which must be overcome in order to obtain the Authority’s targeted results;

4. Responsibility for the timely release of legal advice to assist the Authority in making an informed decision;

5. Ensuring timely compliance with rules and regulations affecting the Authority, including the Code of Conduct and Ethics;

6. Attending to all legal matters of the Authority including advising, vetting and drafting of legal agreements in relation to the Authority’s operations; and

7. Provide legal guidance on contractual and statutory obligations binding to the Organization

8. Coordinate litigations for the Authority.

9. Provide guidance on governance and adherence to statutory obligations.

10. Prepare all Authority contracts, handle all litigation and conveyance matters for the Authority.

11. Facilitate the development of the all Bills and Policies that have bearing on the Authority’s mandate.

12. Establish and manage the Legal Registry.

13. Provide and interpret legal information, conducting training and disseminate appropriate legal requirements to staff.

14. Safeguard the Authority’s interests and ensuring that they are adequately defended   before the courts.

15. Manage, review, and monitor progress of all outstanding litigation.

16. Issue instructions, liaise with the Authority’s appointed Advocates with a view to ensuring they act in the Authority’s interest while handling cases on its behalf.

17. Ensure the Authority complies with constitutional, regulatory and all relevant laws in force through the provision of legal advisory services and contractual risks are efficiently managed.

18. Undertake extensive review of different requests for approval, licenses both internal and external for purposes of ascertaining legal soundness, make appropriate recommendations and ensure proper implementation.

19. Document and maintain a record of all enforcement and compliance assignments undertaken by the Authority’s officers and develop legal accountability structures in relation to enforcement assignments.

20. Continuously manage, review and updating of all the Authority’s codes, regulations, rules, guidelines, by-laws for consistency with each other, and also compliance with the National and County Legal Frameworks.

21. Establish and manage the Authority’s Alternative Dispute Resolution Mechanism.

22. Develop the Authority’s proactive and preventive legal policies and strategies aimed at forestalling disputes, controversies and litigation.

23. Attend Board Meetings in the absence of the Corporate Secretary

24. Arrange and participate in stakeholder engagements (ICPSK, IOD, SCAC, AG).

JOB PROFILE

The Deputy Director, Corporate Communications, will provide strategic leadership in managing the reputation, brand, and public image of the Social Health Authority (SHA). This role is responsible for developing and implementing communication strategies, stakeholder engagement, media relations, crisis communication, and public awareness campaigns. The position ensures effective internal and external communication, promotes transparency, and enhances SHA’s visibility and public trust. Additionally, the role oversees digital and social media strategies, corporate branding, and compliance with relevant communication policies and guidelines.

QUALIFICATIONS

1. Fifteen (15) years relevant work experience, three (3) of which must be in the grade of Assistant Director, Customer experience   or in a comparable position in public service or private sector;

2. Master’s degree in any of the following disciplines: Public Communication, Public Relations, or Mass Communication Marketing or its equivalent qualification from a recognized institution;

3. Bachelor’s degree in any of the following disciplines: Public Communication, Public Relations, Mass Communication, Marketing or its equivalent qualification from a recognized institution;

4. Management course lasting not less than four (4) weeks at a recognized institution;

5. Be a registered member of a relevant professional body

6. Proficiency in computer application; and

7. Demonstrated integrity, professional competence, and management capabilities as reflected in work performance and results

Key Competencies and Skills

1. Ability to think strategically and innovatively

2. Proven intellectual leadership in managing people and financial resources

3. Excellent interpersonal, management, and communication skills

4. Excellent organizational skills and highly confident

5. Computer literacy and familiarity with standard office computer applications

6. Ability to mobilize resource

7. Negotiation skills

1. Formulating and implementing corporate communication policy;

2. Controlling the usage of audio-visual equipment;

3. Participating in welfare activities as and when required;

4. Coordinating publishing of authority’s newsletters and journals;

5. Promoting the corporate image of the authority;

6. Maintaining channels of communication;

7. Placing advertisement or announcement articles in print media;

8. Ensuring proper coverage of authority activities;

9. Ensuring safe custody of equipment in the department;

10. Reviewing corporate communication budget; and

11. Reviewing publication and submission of SHA annual reports, among others.

12. Lead the development, implementation, and evaluation of strategic, tactical, and operational customer engagement plans, programs, and initiatives to align with the organization’s strategic plan 

13.  Advise Management on customer satisfaction measures, Customer Experience   strategies, programs, initiatives, and emerging issues to enable customer-centric strategic decision processes and major or critical issues response 

14.  Plan and provide leadership to the implementation of integrated customer engagement and communication initiatives to improve and enhance the perceptions and experiences of customers

15.  Lead and/or direct specific customer research programs, dialogue, and other forms of engagement to understand key concerns and issues and inform review and enhancement of Customer experience s and service delivery models 

16.  Drive the development of a Customer experience culture across the organization, supported by effective policy and process frameworks and responsive Customer Experience    systems to embed best practice customer-centric behaviors

17.  Identify opportunities for enhanced service delivery through the use of technology to optimize customer experience

JOB PROFILE

To provide strategic leadership and direction on corporate Information and Communication Technology services including selection, acquisition, development and installation of all ICT systems, applications, and infrastructure.

QUALIFICATIONS

1. At least fifteen (15) years cumulative work experience, three (3) years of which should have been at a level of Assistant Director or in a comparable position in the public or private sector;

2. Bachelor’s degree in any of the following fields: Information Technology, Computer Science, Computer Engineering or equivalent qualification from a recognized institution;

3. Master’s degree in any of the following fields: Information Technology, Computer Science, Computer Engineering or equivalent qualification from a recognized institution;

4. Qualifications in either of the following areas: Certified Information Security Manager (CISM), Certified Information Systems Auditor (CISA), or equivalent Database Management skills (MSSQL/ORACLE/MYSQL/IBM) Web development certifications (PHP, HTML, ASP) or relevant qualifications from a recognized institution.

5. Membership to a professional body where applicable and in good standing;

6. Management course lasting not less than four (4) weeks from a recognized institution;

7. Fulfilled the requirements of Chapter Six (6) of the Constitution

Key Competencies and Skills

1. Leadership skills;                                                

2. Analytical skills;

3. Problem solving skills;

4. Computer Skills;

5. Report Writing Skills

6. Communication Skills

1. Lead, direct, and oversee ICT function and ensure continuous operation and cost-efficiency of the ERP information systems, data analytics systems, networks, database and data security systems.

2. Lead the development and implementation of the Information Systems & Security and Infrastructure and Services departments’ strategic and operational plans and performance measurement that promotes accountability and success.

3. Lead and promote a strong internal ICT customer service culture, ensuring a service delivery approach that is responsive to the operational and strategic needs of the SHA.

4. Oversee the development, implementation, coordination and the preparation of strategic procurement plans and tender specifications for purchasing capital equipment, goods, and services as provided in the annual budget of the Directorate of ICT.

5. Supervise the management of planning, development, deployment, operations, and maintenance of IT based information systems in SHA, including the branches;

6. Supervise the management of secure SHA ICT enterprise infrastructure and services;

7. Guide and coordinate all ICT projects related to selection, acquisition, development, and installation of major information systems for SHA while managing all ICT vendor relationships;

8. development and implementation of systems for data analytics, data quality assurance and accountability for data management and use;

9. Oversee development and implementation of ICT policies.

10. Develop, manage, and monitor the ICT budgets and policy guidelines.

11. Seek innovative, integrated, reliable, and sustainable technology services.

12. promote a culture of continuous improvement and business excellence, recognizing achievement and innovation.

13. Coordinate the development and implementation of systems for data analytics, data quality assurance and accountability for data management and use;

14. Implement and educate on cost effective, best practice and sustainable ICT capability for internal and external stakeholders including Scheme members and healthcare providers.

15. Oversee coordination of ICT needs with other SHA directorates, branch offices and external institutions to support planning and development of information systems.

16. Build a sustainable positive working environment within the ICT department.

17. Coordinate the day to day administrative and operational functions of the department;

18. Coordinates the development and implementation of policies, procedures for effective management of biosafety clearing house and international relations;

19. Coordinate the generation, analysis and posting of Social Health Authority Data

20. Coordinate development and implementation of bilateral and multilateral agreements on SHA programs;

21. Coordinate development and review of project proposals and concept notes on SHA programs;

22. Coordinate the development and review of the Directorate’s technical papers, reports and other submissions for consideration by the Board;

23. Performance management of staff within the directorate

JOB PROFILE

The Deputy Director, Finance and Accounts will be responsible to the Director, Fund management for coordination and management of the Finance and Accounts functions.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) years of which should have been at senior management level or in a comparable position in the public or private sector. 

2. Bachelor’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Business Administration or its equivalent qualification from a recognized institution; 

3. Master’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Auditing, Business Administration or its equivalent qualification from a recognized institution;

4. Management course lasting not less than four (4) weeks at a recognized institution.; 

5. Be a registered member of the relevant professional body;

6. Fulfilled the requirements of Chapter Six of the constitution;

7. Proficiency in Computer application; and

8. Demonstrated merit and ability as reflected in work performance and results

Key Competencies and Skills

1. Conversant with Finance/Accounting Application/Software.

2. Strong analytical and reporting skills

3. Ability to interpret long term plans, programs and budgets developed senior management level 

4. Project management skills

5. Ability to develop plans, programs, SOPS, and coordination of workflows

6. Project management skills

7. Strategic management skills

8. Strong leadership and communication skills

9. Decision making

1. Advising the Director of Funds & Financial Management on the strategic direction of financial Health of Authority.

2. Coordinating annual estimates and the overall budget preparation for the Authority.

3. Preparing and reviewing annual work plans for Finance and Accounts.

4. Consolidate annual work plans for the Authority

5. Developing and implementing reforms in budget processes for Finance and Accounts.

6. Ensuring accurate maintenance of the Financial accounting records and adherence to approved financial policies and procedures.

7. Coordinating responses to queries raised in audit management reports/letters for all Finance and Accounts.

8. Preparing and submitting quarterly and annual accounts for SHA in accordance with approved guidelines.

9. Ensures maintenance and regularly updating general ledgers.

10. Ensuring timely preparation and distribution of accurate financial reports.

11. Performing accurate and timely reconciliations of accounts.

12. Ensure preparation of periodic cash flows reports /projections 

13. Implementing financial management and accounting regulations, systems and procedures as per the PFMA;

14. Coordinating responses to queries raised in audit management reports/letters for the Authority.

JOB PROFILE

The Deputy Director, Funds Management will be responsible to the Director, Fund management for coordination and management of the Funds functions.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which should have been at a senior management level or a comparable position in the public or private sector.

2. Master’s degree in any of the following disciplines: Commerce (Finance/Accounting option), Economics, Business Management, Finance, Business Administration, or equivalent qualifications from a recognized institution.

3. Bachelor’s degree in Commerce (Finance/Accounting option), Economics, Mathematics, Statistics, Business Administration, or equivalent qualifications from a recognized institution.

4. Certified Public Accountant III (CPA K) or equivalent.

5. Membership in a relevant professional body.

6. Management course not lasting less than 4 weeks).

7. Demonstrated integrity, professional competence, and management capabilities in work performance and results.

8. Fulfillment of the requirements of Chapter Six of the Constitution.

9. proficiency in computer applications.

Key Competencies and Skills

1. Strong analytical and reporting skills.

2. Project management and strategic management skills.

3. Ability to interpret and implement long-term plans, programs, and budgets.

4. Proficiency in developing plans, SOPs, and coordination workflows.

5. Excellent leadership, decision-making, and communication skills.

1. Advising the Director of Funds & Financial Management on the strategic direction of funds under their purview.

2. Coordinating annual estimates and the overall budget preparation for all Funds under SHA.

3. Preparing and reviewing annual work plans for the funds.

4. Developing and implementing reforms in budget processes.

5. Liaising with the exchequer and Parent Ministry to ensure timely and complete disbursements of budget allocations for all Funds under SHA.

6. Developing and executing strategies for stakeholder consultations.

7. Monitoring and reviewing financial and physical implementation of Fund-related projects and programs.

8. Ensuring accurate maintenance of the Funds accounts records and adherence to approved financial policies and procedures.

9. Coordinating responses to queries raised in audit management reports/letters for all Funds.

10. Preparing and submitting quarterly and annual accounts for all Funds in accordance with approved guidelines.

11. Ensures maintainace and regularly updating general ledgers.

12. Ensuring timely preparation and distribution of accurate financial reports.

13. Performing accurate and timely reconciliations of accounts.

14. Identify deficits/ gaps in Funding in collaboration with Planning and Linkages 

15. Implementing financial management and accounting regulations, systems and procedures as per the PFMA;

JOB PROFILE

The Deputy Director, Supply Chain Management will provide strategic leadership in the procurement, logistics, and asset management functions of the Social Health Authority (SHA). This role is responsible for developing and implementing supply chain policies, ensuring compliance with the Public Procurement and Asset Disposal Act, 2015, and optimizing procurement processes for efficiency, transparency, and value for money. The position oversees contract management, supplier relationship management, inventory control, and disposal of assets while ensuring adherence to regulatory frameworks and ethical procurement standards.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which should have been at the level of Assistant Director, Supply Chain Management or in a comparable position in the public service/sector;

2. Bachelor’s degree in any of the following disciplines: Supply Chain Management, Commerce (Supplies Management option), Procurement or its equivalent qualification from a recognized institution;

3. Master’s degree in any of the following disciplines: Supplies Chain Management, Commerce (Supplies Management option), Procurement or its equivalent qualification from a recognized institution;

4. Certificate in Management Course lasting not less than two (2) weeks from a recognized institution

5. Be a registered member in good standing of the Kenya Institute of Supplies Management (KISM); 

6. Kenya Institute of Supplies Management (KISM) Practicing License

7. Proficiency in Computer Applications

8. Professional Qualification in CPSP(K) or CIPS(UK)

9. Demonstrated merit and ability as reflected in work performance and results.

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strategic and innovative thinking

4. Strong interpersonal skills

5. Negotiation skills.

1. Lead in formulating and developing policies, plans and strategies in the areas of supply chain including risk management and contractor performance measurement plans;

2. Ensuring the procurement and asset disposal processes are carried out in compliance with the procurement and asset disposal Law;

3. Ensuring development and review of the annual procurement and asset disposal plans in line with the Law and monitoring their implementation;

4. Providing procurement professional opinion to the Chief Executive Officer on all procurement contracts for goods, works, services and consultancies as well as asset disposal processes;

5. Ensuring development and implementation of the Supply Chain Strategy and reporting in line with policies, processes & procedures;

6. Overseeing the management of inventory, stores and assets in compliance with the guidelines issued by SHA, Public Procurement regulatory Authority and the National Treasury;

7. Ensuring development and maintaining of an information communication technology inventory management system which shall comply with the Law;

8. Ensuring preparation of statutory and administrative procurement and asset disposal reports as required by the SHA and other Government bodies;

9. Ensuring Monitoring Contract management to ensure conformity with the contract terms and conditions of contract, and reporting to the Chief Executive Officer on any significant departures from the terms and conditions of the contract.

10. Leading in capacity building programs in SHA Supply Chain to ensure compliance with the procurement Law and SHA’s procurement policies and procedures.

11. Ensuring development and management of the supply chain, capability and culture that reflect the values which facilitate performance, professionalism and initiative by staff throughout the Authority;

12. Ensuring that procurement and asset disposal records and data are maintained in accordance with the Law; 

13. Ensuring that the market survey is done in accordance with law to inform adjudication and award by the Chief Executive Officer and subsequent placing of orders;

14. Co-ordinating internal monitoring and evaluation of the procurement and supply chain function;

15. Advising the Authority on aggregation of procurement opportunities to promote economies of scale.

JOB PROFILE

The Deputy Director is the principal assistant to the Director and is responsible for assessing processes and systems of internal controls put in place by the management to ascertain their efficiency and effectiveness. Upon assessment and establishing any weaknesses the department will make recommendations which if implemented will enable the Authority to achieve its strategic objectives.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) years of which should have been at senior management level or in a comparable position in the public or private sector. 

2. Bachelor’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Business Administration or its equivalent qualification from a recognized institution; 

3. Master’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Auditing, Business Administration or its equivalent qualification from a recognized institution;

4. Certified Public Accountants (CPA) Kenya Part III;

5. Management course lasting not less than four (4) weeks at a recognized institution.; 

6. Be a registered member of the relevant professional body;

7. Fulfilled the requirements of Chapter Six of the constitution;

8. Proficiency in Computer application; and

9. Demonstrated merit and ability as reflected in work performance and results

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strong interpersonal skills

4. Negotiation skills

1. Plan and allocate teams for the execution of audit assignments as per the approved annual audit plan

2. Ensure that Internal Audit teams perform and prepare reports for the given assignments within the provided timelines

3. Reviewing audit findings with auditees and prepare final audit reports for the specific audit findings

4. Ensuring maintenance of high audit standards, adherence to plans, budgets and work schedules

5. Maintaining an accurate and up to date database of audit findings, recommendations and implementation status

6. Ensure adherence to the prescribe Internal Audit standards in planning and execution of audit assignments

7. Providing leadership in conducting of specific audit assignments 

8. Managing specific audit assignments by monitoring/tracking progress of assignments allocated to auditors

9. Setting performance targets and assessing performance of staff within the department

10. Planning and managing the start and closure of audit assignments by attending entry and exit meetings with the auditees

JOB PROFILE

The Deputy Director is the principal assistant to the Director and is responsible for assessing processes and systems of internal controls put in place by the management to ascertain their efficiency and effectiveness. Upon assessment and establishing any weaknesses the department will make recommendations which if implemented will enable the Authority to achieve its strategic objectives.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) years of which should have been at senior management level or in a comparable position in the public or private sector. 

2. Bachelor’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Business Administration or its equivalent qualification from a recognized institution; 

3. Master’s degree in any of the following disciplines: Commerce (Accounting/Finance option), Economics, Mathematics, Statistics, Auditing, Business Administration or its equivalent qualification from a recognized institution;

4. Certified Public Accountants (CPA) Kenya Part III;

5. Management course lasting not less than four (4) weeks at a recognized institution.; 

6. Be a registered member of the relevant professional body;

7. Fulfilled the requirements of Chapter Six of the constitution;

8. Proficiency in Computer application; and

9. Demonstrated merit and ability as reflected in work performance and results

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strong interpersonal skills

4. Negotiation skills

1. Plan and allocate teams for the execution of investigations assignments on reported and suspected cases.

2. Coordinate the performance of special audits as and when a request is made by the Board or Management.

3. Ensure that Internal Audit teams allocated to perform investigations/ special audits prepare reports of the allocated assignments within the provided timelines.

4. Analysing investigation reports by reviewing methodology used, accuracy of findings, completeness and consistency of recommendations and taking relevant corrective action.

5. Reviewing and finalize investigation reports for submission to Management and the Board.

6. Ensuring maintenance of high audit standards, adherence to plans, budgets and work schedules.

7. Assisting the Director in formulating and implementing collaborative mechanisms with other relevant government investigating agencies.

8. Provide assurance that the processes, tools and reporting deployed by Risk Management at functional areas are adequate and effective.

9. Evaluate the effectiveness of mitigating measures or actions or programs of work undertaken by functional units to remediate identified gaps and / or revised requirements in risk management.

10. Prepare a report to the Board and Management giving assurance that key risks and controls have been identified and are working well.

11. Evaluating internal control framework put in place for preventing and detecting fraud and irregularities

12. Supporting and providing input in the preparation of the corporate risk register

13. Setting performance targets and assessing performance of staff within the department

14. Managing the “close out” of investigations and special audits.

JOB PROFILE

The Deputy Director, Claims and Case Management will provide strategic leadership in the administration, processing, and resolution of health insurance claims within the Social Health Authority (SHA). This role is responsible for developing and implementing claims management policies, ensuring efficiency, accuracy, and compliance with the Social Health Insurance Act, 2023, and other regulatory frameworks. The position oversees claims adjudication, fraud detection and mitigation, dispute resolution, and case management to enhance service delivery and financial sustainability. Additionally, the role ensures seamless coordination with healthcare providers, members, and regulatory bodies to uphold transparency and accountability in claims processing.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which must have been at Assistant director Claims Management level or a comparable position in the public or private sector.

2. Bachelor’s degree in Medicine and surgery, from a recognized institution. 

3. Master’s degree in Medicine and Surgery, or health-related fields from a recognized institution.

4. Management course lasting not less than four (4) weeks from a recognized institution.

5. Membership to the relevant professional body in good standing.

6. Valid Practicing license.

7. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

8. Meet the requirements of Chapter Six of the Constitution of Kenya.

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strong interpersonal skills

4. Negotiation skills

1. Ensure strategic and operational planning for claims management, defining, risk assessments and monitoring progress against strategic objectives in collaboration with other departments;

2.  Ensure Formulation and implementation of policies and strategies for effective and efficient claims management;

3. Coordinate reviewing, processing and validating medical claims from healthcare providers and healthcare facilities;

4. Ensure issuing of pre-authorizations for access to healthcare services based on the benefit package;

5. Ensure appraising medical claims based on the benefit package;

6. Coordinate quality assurance surveillance and claims adjudication in respect of claims;

7. Establishing systems and controls for detecting and identifying fraud appropriate to the Fund’s exposure and vulnerability in collaboration with other departments

8. Oversee Sensitization of claimants on the consequences of submitting false and fraudulent claims;

9. Ensure effective collection and analyzing of data for purposes of claim management in collaboration with other departments. 

10. Coordinate collaborations with relevant entities in the Health Needs Assessment for clinical interventions and other technologies;

11. Ensure preparation of reports on claims 

12. Ensure effective implementation and continuous improvement of Claims management information systems, ensuring they support efficient operations and member satisfaction in collaboration with the relevant entities in collaboration with other departments. 

13. Establish and refine robust internal claims management controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders. 

14. Ensure compliance with local and international standards in Claims Management (as prescribed in the Act), fostering alignment with globally recognized best practices and enhancing the Authority’s reputation.

15. Ensure the development and execution of policies and strategies for business process re-engineering, driving innovation and efficiency in Claims Management.

16. Provide expert guidance in Claims management on reviewing and amending the Social Health Insurance Act, ensuring responsiveness to the evolving healthcare landscape and adherence to quality standards.

JOB PROFILE

The Deputy Director, Benefits Management will provide strategic leadership in the design, administration, and optimization of health benefit packages under the Social Health Authority (SHA). This role is responsible for developing and implementing benefits management policies, ensuring compliance with the Social Health Insurance Act, 2023, and enhancing accessibility, affordability, and quality of healthcare services for beneficiaries. The position oversees provider contracting, benefit utilization monitoring, cost containment strategies, and member education to ensure equitable and sustainable healthcare coverage. Additionally, the role collaborates with stakeholders to enhance service delivery, data-driven decision-making, and continuous improvement in benefits administration.

QUALIFICATIONS

1. Fifteen (15) years cumulative experience, three (3) of which must have been at Assistant director Benefits Management level or a comparable position in the public or private sector.

2. Bachelor’s degree in any of the following Medicine, Health Financing, Health Economics, Acturial Sciences, Pharmacy, Statistics, Mathematics, Dentistry, or equivalent qualification from a recognized institution.

3. Master’s degree in Health Economics, Health Financing, Business Administration, Statistics, Medicine, Mathematics, Public Health, Health System Management, or health- related discipline from a recognized institution.

4. Management course lasting not less than four (4) weeks from a recognized institution.

5. Membership to the relevant professional body in good standing.

6. Valid Practicing license.

7. Demonstrate a clear understanding of the SHI Act, 2023, and other laws relevant to SHA operations.

8. Meet the requirements of Chapter Six of the Constitution of Kenya.

Key Competencies and Skills

1. Strong analytical skills

2. Communication skills

3. Strong interpersonal skills

4. Negotiation skills

1. Ensure strategic and operational planning for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.

2.  Ensure Formulation and implementation of policies and strategies for effective and efficient Health Benefits management in collaboration with other departments.

3. Coordinate the strategic purchasing of prescribed benefit packages in close collaboration with the Directorate of Fund Management and other departments ensuring efficiency, equity, and cost-effectiveness in service delivery.

4. Collaborate with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs. 

5. Coordinate the implementation of the prescribed Benefits packages and Tariffs under the Primary Healthcare Fund for level 2, 3, and select 4 providers and facilities; under the Social Health Insurance Fund in level 4, 5 and 6 providers and facilities and the Emergency, Chronic and Critical Illness Fund in level 2-6 facilities and providers. 

6. Analyze the cost-effectiveness, affordability, budget impact of health benefit offerings and recommend optimizations to maintain sustainability. 

7. In collaboration with the Benefit Package & Tariffs Advisory Panel, ensure the benefits packages and tariffs design, review and implementation processes are transparent and inclusive through stakeholder engagement. 

8. Coordinate the effective implementation and continuous improvement of Benefits and Tariffs management information systems, ensuring they support efficient operations and member satisfaction.

9. Provide guidance in collecting and analysing data for purposes of health Benefits management in collaboration with other departments. 

10. Coordinate preparation of reports on Benefits Management

11. Establish and refine robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders. 

12. Analyze the cost-effectiveness of benefit offerings and recommend optimizations to maintain sustainability.

13. Coordinate effective collaboration with external stakeholders.

14. Ensure compliance with local and international standards in Benefits Management (as prescribed in the Act), fostering alignment with globally recognized best practices and enhancing the Authority’s reputation.

15. Coordinate the development and execution of policies and strategies for business process re-engineering, driving innovation and efficiency in Benefits Management.

16. Provide expert guidance in Benefits management on reviewing and amending the Social Health Insurance Act, ensuring responsiveness to the evolving healthcare landscape and adherence to quality standards.

JOB PROFILE

The Deputy Director, Beneficiary Management will provide strategic leadership in the registration, enrollment, and management of beneficiaries under the Social Health Authority (SHA). This role is responsible for developing and implementing policies to enhance beneficiary identification, eligibility verification, data integrity, and service accessibility in compliance with the Social Health Insurance Act, 2023. The position oversees membership registration, database management, grievance resolution, and stakeholder engagement to ensure seamless beneficiary experiences. Additionally, the role ensures the continuous improvement of beneficiary management systems through data-driven decision-making, technology integration, and process optimization.

QUALIFICATIONS

1. Must have at least fifteen (15) years’ cumulative work experience, three (3) of which should have been at the level of Assistant director  or in a comparable position in the public or private sector;

2. Bachelor’s degree in commerce, Accounting, Business Administration, Finance or Economics, Business, Medicine, Social Science, Pharmacy equivalent qualification from a recognized institution.

3. Master’s Degree in any of the following: Strategic Management, Finance, Business Administration or equivalent qualification from a recognized institution.

4. Member of the relevant professional body;

5. Management course lasting not less than four weeks;

6. Proficiency in computer applications;

7. Relevant years of experience;

8. Meet the requirement of chapter 6 of the Constitution of Kenya.

Key Competencies and Skills

1. Reporting skills;

2. Analytical skills;

3. Good Communication skills;

4. Good Interpersonal skills; and

5. Good Organizational skills

1. Ensuring compliance with SHI ACT related policies and legislation, on all operational activities.

2. Leading the development, implementation, monitoring and reviewing of sustainable operational strategies relating to beneficiary registration.

3. Liaising with the Strategy and Planning team in the development, implementation and review of Authority’s policies relating to beneficiary management business process, re-engineering as well as strategic business units expansion and enhancement.

4. Leading stakeholder engagement activities that will enhance the achievement of set targets in beneficiary registration.

5. Formulate and provide guidance on initiatives to increase enrollment by SHA beneficiaries

6. Assisting in the provision of technical advice to the Chief Executive Officer and Board of Management on issues pertaining to beneficiary registration.

7. Developing and implementing strategies that enhance membership and revenue growth. 

8. Developing and implementing policies on strategic business units network expansion that will ensure services are accessible across the country. 

9. Ensuring both employer and individual member accounts are managed appropriately. 

10. Developing and implementing policies and strategies on business process re-engineering.

11. Overseeing entrenchment of the Universal Health Coverage (UHC) and other Sponsored Programs in the Authority.

12. Overseeing beneficiary choice of primary healthcare providers and disbursement of capitation payments.

13. Spearheading the implementation of customer service strategies in the Authority.

14. Liaising with ICT on implementation, adoption and monitoring utilization of the beneficiary self-care platforms.

15. Making recommendations to the Management on identification and mitigation of beneficiary induced fraud.

16. Negotiating with the service provider and overseeing implementation of Emergency Evacuation benefits to Authority members.

17. Preparing concept papers, Board papers, periodic progress reports and annual reports showing sectional achievements against planned targets as well as providing justification for performance variances and areas of improvement.

JOB PROFILE

The Deputy Director, Provider Management will provide strategic leadership in the accreditation, contracting, and performance oversight of healthcare providers under the Social Health Authority (SHA). This role is responsible for developing and implementing provider management policies to ensure high-quality healthcare service delivery, cost efficiency, and compliance with the Social Health Insurance Act, 2023, and other relevant regulations. The position oversees provider credentialing, contract negotiations, service quality monitoring, and dispute resolution while fostering strong partnerships with healthcare facilities. Additionally, the role ensures continuous improvement in provider management systems through data-driven decision-making and stakeholder engagement.

QUALIFICATIONS

1. Must have at least fifteen (15) years’ cumulative work experience, three (3) of which should have been at the level of Assistant director  or in a comparable position in the public or private sector;

2. Bachelor’s degree in commerce, Accounting, Business Administration, Finance or Economics, Business, Medicine, Social Science, Pharmacy equivalent qualification from a recognized institution.

3. Master’s Degree in any of the following: commerce, Accounting, Bu``siness Administration, Finance or Economics, Business, Medicine, Social Science, Pharmacy equivalent qualification from a recognized institution.

4. Member of the relevant professional body;

5. Management Course lasting not less than four (4) weeks from a recognized institution.

6. Proficiency in computer applications;

7. Relevant years of experience;

8. Meet the requirement of chapter 6 of the Constitution of Kenya.

Key Competencies and Skills

1. Strategic Leadership and Governance

2. Stakeholder Engagement and Communication Skills

3. Financial and Risk Management Expertise

4. ICT Proficiency and Data-Driven Decision Making

5. Strong Ethical Practices and Good Governance

6. Ability to Foster Innovation and Institutional Growth

1. Health Facilities Assessment and Onboarding: Develop and coordinate the implementation of policies and strategies for assessing and onboarding healthcare providers (HCPs).

2. Policy and Legislative Reviews: Advise on necessary reviews of the SHI ACT and propose amendments aligned with the evolving business environment and quality standards.

3. Stakeholder Engagement: Spearhead forums for engaging healthcare providers to enhance collaboration and service delivery.

4. Empanelment of Overseas providers; In consultation with Supply Chain Management and Legal Services, ensure the empanelment of overseas HCPs to expand service accessibility.

5. Quality Assurance and Improvement: Oversee the implementation of the Kenya Quality Model of Health (KQMH) in empaneled healthcare providers to uphold quality standards.

6. Reporting and Documentation: Prepare concept papers, Board papers, periodic progress reports, and annual reports detailing departmental achievements against planned targets.

7. Awards and Sanctions: Develop strategies for awarding healthcare providers who deliver quality services and sanctioning those that fail to meet standards.

JOB PROFILE

The Deputy Director provides an overall oversight on the corporate strategy, for a portfolio of critical functions within the Authority, including Strategy and Transformation; Research and Informatics; and Monitoring, Evaluation, Accountability, and Learning (MEAL). This role is responsible for ensuring the effectiveness, efficiency, and impact of all programs and initiatives undertaken by the Authority.

QUALIFICATIONS

1. Master’s degree in Public Health, Statistics, Business Administration, Strategic Management, Health Systems Management, Public Policy, Development studies, or their equivalent from a recognized university.

2. Bachelor’s degree in health related or health systems, statistics, strategy and planning related courses.

3. Management course lasting at least four (4) weeks, from a recognized institution.

4. 15 years of cumulative work experience, three (3) of which are in an Assistant director or similar position; progressive leadership experience in strategy, partnerships, or business development within the healthcare or insurance sector.

5. Experience applying for, negotiating or managing high-value partnerships.

Key Competencies and Skills

1. Report writing skills;

2. Communication skills;

3. Problem solving skills

4. Negotiation skills; 

5. Critical thinking skills; 

6. Analytical skills; 

7. Interpersonal skills

1. Oversee the development and implementation of the corporate strategic vision aligned to the national health strategy and priorities

2. Lead the development and implementation of robust MEAL frameworks and systems across all programs and initiatives.

3. Oversee the development and implementation of strategic partnerships with key stakeholders, including government agencies, NGOs, academic institutions, and private sector organizations.

4. Provide thought leadership and expertise on health insurance research, data analytics, and the use of data to inform program design, sustainability, implementation, and improvement.

5. Oversee the development and management of programs and projects; work plans, budgets, and key achievements for the Authority.

6. Ensure effective coordination and collaboration across the different strategic delivery units.

7. Monitor program progress, identify and address challenges, and ensure timely and effective program implementation.

8. Lead and/or participate in research activities related to health insurance coverage, utilization, quality of care, and health outcomes.

9. Promote innovations; including data analytics and technologies; to improve programs’ effectiveness and efficiency.

10. Oversee systematic review of the global, regional, national and sub-national best practices in social health insurance, public health, and program evaluation.

11. Build and maintain strong relationships with key stakeholders, including government, policymakers, researchers, and academic institutions.

12. Effectively communicate program findings and results to internal and external stakeholders through reports, presentations, and publications.

JOB PROFILE

The Chief Executive Officer shall oversee the day-to-day operations of SHA under the guidance of the Board. The CEO will be responsible for administering the Funds established under the Social Health Insurance Act, developing strategies, and implementing Policies to achieve the Authority’s objectives. The CEO will also represent SHA in high-level engagements with stakeholders and ensure the Authority’s sustainability through prudent resource management. The CEO will ensure that the existing Government Financial and Procurement Regulations shall, to the extent they relate to the administration of public Funds established under the Public Finance Management Act, No. 18 of 2012 apply in the administration of the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund.

QUALIFICATIONS

Applicants must meet the following minimum requirements as stipulated under the Social Health Insurance Act, 2023:

1. Be a Kenyan citizen.

2. Has a minimum of a master ’s degree from a university recognized in Kenya;

3. Has at least ten years' knowledge and experience in health insurance, health financing, health Economics, healthcare administration or any other relevant field;

4. Has served in a management level for a period of at least five years;

5. Has not been convicted of an offence and is not serving a term of imprisonment; and

6. Meets the requirements of chapter six of the Constitution.

KEY COMPETENCIES

1. Ability to think strategically and innovatively;

2. Proven intellectual leadership in managing people and financial resources;

3. Excellent interpersonal, management and communication skills;

4. Excellent organizational skills and highly confident;

5. Proficiency in Computer application;

6. Negotiation skills.