Direct Assurance
Vacancy Advertisement
We are looking for a motivated and qualified professional to fill the position of Senior Claims Officer.
Overall Purpose of the Job: The role holder will be responsible for managing the administrative, co-ordination and operations of the Claims, supervising staff in the section;
The position shall provide high level support to the Claims Manager making important contributions to the financial and operating success including preparing reports and registers, file allocation and diary management when required from time to time;
Key Roles and Responsibilities
Management and Co-ordination
- Assist the Claims manager in supervision and management of the Claims Department
- Supervise the assigned staff within the Claims Department and ensuring that the highest quality of service is rendered to the company and the staff comply with the company policies and guidelines
- Be the link between the claims department and other departments
- Participate in the recruitment and training of quality members of staff in the Claims department
Claim and Incident Management
- Thorough review and detailed analysis of claim documents to enable early fraud detection and ensure that the fraudulent claims are effectively addressed within the company’s policies and guidelines.
- Maintain a proper and accurate reserves on claims and incidents.
- Approve new claims into the system in a timely manner;
- Approve claims payments as per the approval matrix.
- Clearance of tasks from the DLBMS system
- With the assistance of the Claims Officers, Review Reports from service providers and where necessary engage them to be able to provide appropriate opinion on the claim.
- Where Summons are received from Third parties, to have our advocates immediately instructed to enter appearance and file defense to protect the interest of our insured’s.
- Communicate with intermediaries and direct clients to obtain information necessary for processing of claims, liaise with the underwriters, beneficiaries, departments and subsidiary offices to facilitate claims processing
- Maintain a proper update of the system data and documentation of the claims and incidents and ensure that the files submitted by the Claims officers are approved within 24 hours of posting.
- Ensure that correspondences from the insured, intermediaries, claimants and their advocates are responded to within 72 hours from the date they are received.
- Ensure that proper factual and legal research required for achievement of the strategy on the claims is conducted
- Closely monitor any legal threat including court judgments, proclamations, warrants of attachment and provide update on the measures taken to the Claims Manager for information and follow up.
- Ensure that recoveries from the insured and third parties is achieved
- Continuously prepare and review the relevant claim guidelines and template documents to conform to the policy and best practices.
- Handle customer complaints from the insured or intermediaries and instill confidence in the company’s claim process
- Prepare relevant departmental and management reports for analysis when required
Reports
- Preparing reports to the Claims and Risk Committees on the legal implications of adopting proposed policies and strategies on the management of claims
- Preparation of monthly performance reports of the departmental staff
- Preparation of monthly Claim Reports for internal and external use
- Preparing relevant claim and incident reports for presentation to the relevant Board Committees.
- Preparing necessary returns on the Claims portfolio to the Industry Regulator and other stakeholders.
General Duties
- Review of the Claims IT system and workflow and making recommendations on modification
- Conducting training and other forms of relevant training.
- Providing advice on the effects/implications of any proposed changes on policy documents and preparing responses to consulting documents’
- Review contracts and agreements from stakeholders and identifying opportunities for efficiencies and improvements.
- Monitoring changes in relevant legislation and the regulatory environment, and advising the company on the impact of such changes
- Attending court to represent the Company as a witness or any other capacity as may be approved by the Company
- Participate and offer valuable advice to the Company and/or Departmental Committees which you are nominated or elected to.
- Represent the Company in meetings with Industry Stakeholders and proving the Company with the requisite reports from such meetings
- Signing the relevant and authorized documents on behalf of the Company
- Maintain highest level confidentiality concerning the sensitive, strategic and other information, data, decisions and developments taking place at the company.
- Any other duties that maybe assigned from time to time.
Person Specifications
Academic Qualifications
- Bachelor degree in any Business Discipline or its equivalent recognized by Commission for Higher Education.
Professional Qualifications.
- AIIK Diploma /CII Diploma or great progress thereof or any other recognized insurance related qualifications.
Experience
- At least 5 Years’ experience in claims management preferably within the Insurance industry.
Skills and Attributes
- Conceptual and analytical, managerial and decision-making skills;
- A very high level of attention to detail.
- High level of organizational skills
- Strong Administrative skills, including proficiency with MS Office applications
- Ability to meet deadlines
- Strong professional communication skills.
- Must be customer centric.
- Ability to get well with diverse workforce;
- Honesty and integrity;
- Positive working attitude;
- Excellent litigation and negotiation skills
- Ability to give and take instructions;
Application Instructions
If you qualify for the above advertised role, kindly send us a detailed CV and Application Letter clearly demonstrating your fit as per the roles & responsibilities and the person specifications (academic / professional qualifications, experience, skills & attributes) listed above.
Applications that do not conform to the Application Instructions will not be considered.
Kindly send your application documents to human.resource@directline.co.ke to reach us on or before 5.00pm 9th September 2022.