Job Summary

The role holder will be responsible for ensuring general insurance claims are accurately assessed, processed and paid in accordance with company regulations and standards.

Key Responsibilities

• Receive reports on new claims and ensure they are promptly registered and handled in accordance with our Customer Service Charter.
• Ensure all claims are handled professionally within the terms and conditions of policies issued.
• Ensure settlement offers and payments are processed promptly in line with set targets
• Evaluate and settle claims in accordance with delegated authority, to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
• Continuously monitor turnaround time of claims and benefits settlement and take or suggest corrective measures where there are gaps in claim process.
• Initiate and actualize claims cost management measures within the Treating Customer Fairly (TCF) guidelines
• Appoint service providers such as assessors, investigators and loss adjusters
• Oversee the preparation of claims statistical reports within the stipulated time
• Verify and analyse data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claims
• Confer with legal counsel on claims requiring litigation
• Undertake portfolio analysis and risk recommendation reporting to underwriting department
• Review reports from service providers and make appropriate recommendations on payment and any further action.
• Preparation of weekly and monthly claims reports for presentation to the Manager for review
• Continuous review of claims reserves to ensure they are adequate at all times
• Deal with general correspondences
• Maintain a high level of service to customers at all points of contact such as telephone calls, emails, letters or personal visits
• Prompt attention to complaints
• Ensure compliance with SLAs by all stakeholders and initiate corrective action for any breach
• Conduct training for intermediaries as may be necessary for them to understand our products
• Be instrumental in implementing strategic objectives
• Supervise all direct reports to ensure productive use of time and maintenance of discipline
• Appraise, train and develop staff for more challenging roles
• Ensure accurate data capture including tagging of service providers
• Participate in the scheduled quarterly reviews of files
• Embrace governance requirements with respect to KYC/AML/Data protection requirements per governing Acts.

Qualifications

• Bachelor’s Degree in Business Management, Insurance, Economics or Related Discipline
• Progress towards Diploma in Insurance (ACII or AIIK), (at least 5 papers or equivalent)

Experience

• 6-8 years’ experience in claims management in the insurance industry

Competencies

• Customer, market and competitor understanding.
• Knowledge of insurance industry and concepts
• Knowledge of insurance regulatory requirements
• Knowledge of medical underwriting processes, procedures and concepts
• Negotiation skills
• Business management skills
• Excellent analytical skills
• Excellent organizational and stakeholder management skills