This role involves assessing, registering, and managing insurance claims from acknowledgment through to settlement, ensuring strict adherence to authorization frameworks, Service Level Agreements (SLA’s), and regulatory compliance. The Claims Officer is also responsible for maintaining excellent client and broker relations and contributing to process improvements.
Key Primary Responsibilities
- Assessing, registering claims, acknowledging, and making recommendations or approvals in line with the Authorization framework & Service Levels Agreements (SLA’s).
- Following up with finance on all claims settled for quick disbursement of claims funds.
- Reviewing claims documents & reports and making suitable recommendations.
- Preparing claims files notes, and organizing claims committee meetings.
- Communicating claims decisions to clients and Brokers as per the Turnaround Times (TAT’s).
- Liaising with reinsurers and other service providers on complex claims.
- Performing reinsurance recovery for claims settled.
- Making recommendations for investigation for all suspicious claims.
- Providing input to business development and underwriting on how to improve products and processes.
- Reviewing claims outstanding, engaging clients and Brokers on outstanding claims documents.
- Attending to clients/Brokers by ensuring their claims issues/concerns are addressed within TAT’s and SLA’s in place.
- Improving and enhancing core systems to improve automation and digitization.
- Reviewing of claims process manual.
- Participating fully in all quality processes improvement, including ISO.
- Performing monthly reconciliation and sign off with Finance on settled claims.
- Strict adherence to customer charter, compliance issues by working and collaborating with Customer service teams, Risk, Audit, AKI, and the Regulators.
- Monitoring & maintaining accurate records and up-to-date claims records both physical and in the LMS.
- Safe keeping and proper use of all company documents, records, and moveable assets assigned to the Team.
- Providing management with the necessary claims reports and confidential reports on claims matters.
- Attending to all client’s/Brokers complaints until successfully resolved.
Generic Duties
- Preparing and monitoring monthly and annual budgets for the respective teams through weekly, monthly, and quarterly production reports and targets.
- Entrenching performance-based appraisal of staff in line with their set KPIs and departmental targets.
- Participating in company CSR and brand building activities in liaison with other departments.
Qualifications and Experience
Academic Qualifications:
- Bachelor’s degree in Insurance/Actuarial Science or an equivalent.
Professional Qualifications:
Experience:
- At least 6 years’ relevant experience.
Job Skills and Requirements
- Leadership skills
- Negotiation Skills
- Time management skills
- Underwriting skills
- Interpersonal and Communication skills
