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Faith Wacoli

@faithwacoli

Health insurance operations specialist at Old Mutual, Kenya, who cut contracted service fees by 7% and improved pre-authorisation turnaround.

Kenya

Message

At Old Mutual, Kenya, I governed clinical and financial compliance across a network of contracted healthcare facilities, using audits to assess billing accuracy, pre-authorisation adherence, and treatment protocols.

I also led provider tariff renegotiations and fee benchmarking, achieving a 7% reduction in contracted service fees and contributing to KES 38 Million in annual cost savings.

As Medical Care Manager at Old Mutual, Kenya, I reviewed pre-authorisation requests and clinical documentation, assessed medical necessity against policy terms, and identified billing anomalies. I also contributed to policy refinements that improved claims payout accuracy and reduced financial leakage.

Earlier, at Minet Kenya Insurance Brokers, I managed inpatient cases, adjudicated pre-authorisations and hospital bills, and coordinated chronic disease care. My clinical foundation comes from nursing roles at Careville Wellness Centre and my Bachelor of Science in Nursing from University of Nairobi.

Experience

Work history, roles, and key accomplishments

Provider Relations & Strategic Partnerships Manager

Old Mutual

Jan 2023 - Apr 2026 (3 years 3 months)

Governed clinical and financial compliance across a panel of 100+ contracted healthcare facilities, conducting quarterly audits and driving corrective action. Led network-wide tariff renegotiations achieving a 7% reduction in service fees and KES 38 Million in annual cost savings.

Provider Relations Contract Negotiation Cost Containment Utilization Review Data Analysis Compliance Auditing Stakeholder Management Reporting

Medical Care Manager

Old Mutual

Oct 2019 - Dec 2022 (3 years 2 months)

Processed and reviewed pre-authorisation requests for 150+ member files monthly, verifying coverage and assessing clinical necessity. Managed claims review, cost containment, and process improvements that reduced turnaround from 5 to 3 working days.

Prior Authorizations Claims Review Clinical Necessity Cost Containment Process Improvement Provider Negotiation Documentation Review

Care Manager

Minet Kenya Insurance Brokers

Jul 2015 - Sep 2019 (4 years 2 months)

Processed and adjudicated pre-authorisation requests and hospital bills for 150+ inpatient admissions annually. Managed active caseloads, identified billing anomalies, and conducted credentialing audits across network facilities.

Prior Authorizations Claims Adjudication Case Management Chronic Disease Management Provider Liaison Audit Bill Review

Head, Nursing Department

Careville Wellness Centre

Jan 2012 - Jun 2015 (3 years 5 months)

Led nursing department clinical operations across all shifts, managing complex patient cases and building foundational clinical assessment skills. Delivered orientation and CPD programmes for nursing staff.

Clinical Operations Patient Management Corporate Trainer Clinical Documentation Protocol Adherence