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.
Qualifications for the Claims Manager
- In liaison with the MD formulating and monitoring the claims Department strategic plans
- 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
- Build a supportive, team-orientated environment for the staff through embodying a sense of empowerment, demonstrating positive thinking and establishing common goals and interdependence with the employees.
- Ensure in-depth, investigation of actual claims through direct or indirect contact with policyholders, claimants, other carriers, physicians, contractors, attorneys 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 timely to reinsurance as required by procedure.
- Co-ordinate and maintain expeditious and efficient processing of claims and ensure customer needs are attended to promptly.
- Ensure compliance with statutory regulatory bodies
- Prepare annual budget for the department and ensure proper budgetary control.
- Analyse 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 manager.
- Set standards (benchmarks) for measuring the performance of strategic customer relationship and communication.
- Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures.
- Confer with legal counsel on claims requiring litigation.
- Develop tools and recommendations for risk management / fraud detection
- Ensure that all claims fall within scope of respective insurance policy.
- Coordinating the preparation of weekly claims statistics.
- Control administrative costs through effective budgeting, appropriate staffing and close monitoring of ongoing expense allocations.
- Identify, appoint and maintain an efficient and effective evaluation of service providers.
- Prepare periodical claims report and other management reports relating to claims and ensure that remedial action is taken promptly
- Set reserves on files and distributed reserve and settlement authority to claims staff within corporate guidelines.
- Any other duties that may be assigned by the MD from time to time.
Qualifications for the Claims Manager Job
- A bachelor’s degree from a recognized University.
- A diploma in Insurance (ACII, AIIK or equivalent)
- Master’s Degree
- 8 years’ relevant working experience, four( 4) of which should have been at Section Head level or above
- Analytical Thinking
- Customer orientation
- Holding People accountable
- Leadership and developing others
- Relationship building for influence
- Team working
- Innovation
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