Purpose for the Job

The position holder will handle allocated clients' claims, the insurance claim process for all general insurance claims in motor, property, liability and work injury claims at both retail and corporate lines.

Duties and Responsiblities

Claims Advisory and Advocacy

• Reviewing and analyzing client claims, applications and adjustments and determining whether a client is covered under their insurance policy and that the claim has been properly adjudicated and processed within reasonable timelines.
• Research, craft and draft appropriate professional and technical responses to claims issues.
• Giving the client a competent insurance policy and a claims expert’s opinion based on sufficient knowledge and analysis of the relevant facts.
• Meeting clients and concerned stakeholders on the ground over complaints and dispute resolution.

Client Account, Claims Relationships

• Manage claims for assigned client accounts, ensuring all insurance policy claims are handled with due diligence and integrity.
• Process claims efficiently and accurately, ensuring prompt payments for all valid claims in accordance with policy terms.
• Maintain effective communication with policy holders to ensure transparency throughout the claims process.
• Ensure that all claims are resolved and finalized within a reasonable and acceptable timeframe, adhering to internal and regulatory standards.

 Maintaining Claims Records, Data and Claims Reporting

• Properly handle client information and storage of claims Documents received and ensure the claim files are always updated.
• Accurately capture claims data in the Core Claims Systems and ensure the claims data is up to date and always correct.
• Prepare monthly reports for clients and management, highlighting claims trends.

Complaints & Issues Handling

• Handling of customer complaints regarding the claims from the portfolio of accounts and by escalation from direct reports.
• Meeting clients and concerned stakeholders on the ground over complaints and dispute resolution.

Key Result Areas

The accountability areas are as follows:

• Client Retention at 100%.
• Claims life cycle lead time at 25 - 30days simple claims and complex claims at 90 - 180days.
• Real-time claims information.
• Claims closure rate at 115% Closed/New for the year.
• Customer satisfaction Index of 85% and net promoter score of 60%.
• Compliance with processes, policies and procedures at 100%.

Key Competencies

• Customer Service Orientation.
• Interpersonal and Communication Skills.
• Problem solving abilities.
• Resilience and persistence.
• Teamwork and collaboration.
• Continuous leaing and adaptability.

Knowledge And Skills Required

• Adept in general insurance claims with an experience of at least 3 years in a busy general insurance claims environment.
• Creative and strategic thinking.
• Strong analytical and risk management capability.
• Excellent computer skills.
• Good organizational skills, agile, resourceful and collaborative.

Professional and Academic Qualifications

• Bachelor’s Degree from a recognized university in a Business / Legal Studies-related discipline.
• Diploma in ACII / AIIK.