The position is responsible for effectively managing and directing all functions of the Claims Department; including budget, staffing, talent management, staff development and performance management, expense control, quality control and service to both external and internal customers
Responsibilities
Financial
- Prepare annual budget for the department and ensure proper budgetary control
- Review analyzed insurance claims to ensure that payments and settlements are made in accordance with company practices and procedures
- Approve claim payments in a timely manner after confirmation of admissibility
- Contribute to and enforce the reserving policy in liaison with the actuarial department
Customer
- Ensure all claims reported are processed expeditiously, within the company’s performance benchmarks
- Coordinate efforts among staff and other parties to achieve timely, equitable disposition of claims handled in the Claims
Department
- Resolve complex, severe exposure claims, using high service oriented file handling
- Comply with customer protocols/service charter
Process
- Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a sustainable loss ratio
- In conjunction with GM Operations, establish specific goals for claims handling and develop and implement a tactical plan to support goal attainment relative to productivity, loss ratio, loss and loss adjustment expenses and other agreed upon metrics
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
- Ensure in-depth investigation of claims through direct or indirect contact with policyholders, claimants, physicians, contractors and advocates ensuring that any detected fraud case is handled as per company policy guidelines.
- Control and direct activities of defense counsel, directly or indirectly through staff
- Ensure all applicable claims are reported accurately and promptly to reinsurance as required by procedure
- Ensure compliance with statutory regulatory bodies and serve as lead contact on matters pertaining to claims
- Analyze claims data to identify issues, and ensure that all relevant issues relating to underwriting policies, re-insurance arrangements, and product pricing are identified and communicated to relevant managers
- Proactively respond to company and industry trends
- Develop tools and recommendations for claims risk management/ fraud detection
- Identify, appoint and maintain an effective panel of claim service providers
- Prepare periodical claims report and other management reports relating to claims and ensure that any necessary remedial action is taken promptly
- Any other duties that may be assigned from time to time
Learning and Growth
- Recruit and motivate employees in line with the organization strategic plans a and ensure compliance with company HR policies/ procedures
- Facilitate and support talent management, performance management and development
- Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications.
- Review, monitor and provide technical expertise to staff and ensure that there is systematic and adequate on job training
Qualifications and requirements
- A bachelor’s degree from a recognized University.
- A diploma in Insurance (ACII, AIIK or equivalent)
- 7 years’ relevant working experience, four (4) of which should have been at Manager level or above
Key Performance
Indicators
- Competent in prioritizing and working with little supervision, be self-motivated and trustworthy.
Personal attributes
- People Management: Able to identify, impact and influence others. Able to promote team working with peers, share knowledge and resources with peers and across functions
- Problem Solving and Decision Making: Ability to make and record effective decisions when they are needed following the appropriate decision making criteria, framework or guidance even if they prove difficult or unpopular
- Communication skills- Excellent written and verbal communication with a variety of stakeholders including colleagues, business partners, board of directors and regulators
- Industry Knowledge- A professional/expert in claims handling and management and knowledge of general insurance underwriting
- Must be well groomed and possess excellent office etiquette.
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