Job Ref. No: JHIL161

Role Purpose

The Third-Party Fund Administrator (TPA) will oversee the management and administration of funded schemes. This role ensures efficient utilization, accurate reporting, and proper allocation of funds, while maintaining strong relationships with clients and healthcare providers. The role will also play a key role in underwriting processes to minimize risks and ensure compliance with regulatory requirements.

Key Responsibilities

Strategy

• Develop and implement strategies to optimize the utilization of medical insurance funds.
• Forecast fund requirements based on claims trends, risk assessments, and actuarial insights.
• Collaborate with underwriting & actuarial teams to design pricing models and policies that align with strategic objectives.
• Identify potential risks related to fund mismanagement, fraud, or over-utilization and propose mitigation strategies.
• Provide insights on industry trends and emerging practices in fund administration to enhance competitive advantage.
• Align fund management strategies with client needs, company objectives, and regulatory frameworks.
• Lead initiatives to strengthen relationships with key stakeholders, including insurers, healthcare providers, and corporate clients.

 Operational

• Manage fund utilization and monitor balances to avoid shortfalls or overages.
• Ensure timely collection of replenishments and deposits to client fund accounts.
• Process medical claims within agreed timelines and ensure accurate reconciliation with allocated funds.
• Review, process, and approve claims based on set policies and procedures.
• Prepare and present detailed fund utilization and performance reports for internal and external stakeholders.
• Address disputes or discrepancies in claims or fund balances, ensuring prompt resolution.
• Identify and implement process improvements to enhance the efficiency of fund administration operations.
• Use data analytics tools to track fund performance and streamline decision-making processes.

 Corporate Governance

• Ensure all fund administration activities are in compliance with local laws, company policies, and industry regulations.
• Maintain strict confidentiality and data privacy for all financial transactions and client records.
• Conduct regular fund audits and implement internal controls to ensure transparency and accountability.
• Prepare for and manage external audits, providing necessary documentation and explanations.
• Develop and enforce policies and guidelines for fund management and underwriting operations.
• Ensure all stakeholders adhere to corporate governance standards in fund administration processes.

Leadership & Culture

• Build and maintain strong relationships with healthcare providers, corporate clients, and insurers.
• Act as the primary contact for TPA clients, resolving issues and ensuring high satisfaction levels.
• Regularly engage with clients and partners to understand their needs and improve service delivery.

Key Skills and Competencies

• Proficient in managing, allocating, and reconciling funds for medical underwriting and claims.
• Expertise in tracking fund utilization and ensuring adherence to agreed limits.
• In-depth understanding of medical insurance underwriting principles, risk assessment, and pricing strategies.
• Ability to evaluate medical claims and align them with underwriting policies.
• Skilled in verifying and approving medical claims based on policy terms and fund availability.
• Competence in managing claims workflows to ensure efficiency and accuracy.
• Proficient in analyzing fund performance, utilization trends, and identifying anomalies.
• Strong ability to prepare and present detailed reports on fund administration and claims activity.
• Effective at coordinating with insurers, healthcare providers, clients, and internal teams to address fund-related inquiries.
• Skilled in building and maintaining strong stakeholder relationships for seamless operations.
• Strong understanding of regulatory frameworks governing fund administration and medical underwriting.
• Experience in implementing measures to ensure compliance and mitigate risks, including fraud detection.
• Capability to identify inefficiencies in fund management and claims processing, and recommend improvements.
• Skilled in creating and maintaining fund administration policies that align with organizational and regulatory standards.

Academic & Professional Qualifications

• A Bachelor’s degree in Actuarial or a Business-related course.
• Mandatory Insurance Professional qualification.
• Proficient in the use of Microsoft Office Suite and packages.

 Relevant Experience

• Minimum of 3 years of experience in fund administration, medical underwriting, or similar roles in the insurance industry with proven experience managing large-scale funds, claims, and stakeholder relationships and familiarity with Third Party Administration (TPA) services, including claims processing, provider network management, and client onboarding.

How to Apply

If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 11th March 2025. Only shortlisted candidates will be contacted.