Role Overview
The position holder will handle allocated clients' claims and oversee the insurance claim process for all general insurance claims in motor, property, liability, and work injury claims across both personal and commercial lines.
Duties and Responsibilities
Claims Advisory and Advocacy
- Review and analyze client claims, applications, and adjustments to determine coverage under their insurance policy and ensure claims are properly adjudicated and processed within reasonable timelines.
- Research, craft, and draft appropriate professional and technical responses to claims issues.
- Provide clients with competent insurance policy and claim expert opinions based on sufficient knowledge and analysis of relevant facts.
- Meet clients and concerned stakeholders over complaints and dispute resolution.
Client Account & Claims Relationships
- Handle claims for allocated client accounts, ensuring claims made by clients on their insurance policies are dealt with prudently, processed efficiently, and payments for valid claims are made quickly.
- Coordinate all required services following an accident or incident among policyholders and insurance partners/actors.
- Handle customer complaints regarding claims from the portfolio of accounts and by escalation from direct reports.
Maintaining Claims Records, Data and Claims Reporting
- Properly handle client information and storage of received claims documents, ensuring claim files are always kept updated.
- Accurately capture claims data in Core Claims Systems and ensure data remains up to date.
- Prepare monthly reports for clients and management highlighting claims trends.
Complaints & Issues Handling
- Manage customer complaints regarding claims from portfolio accounts and via escalation.
- Meet clients and concerned stakeholders on the ground for complaint resolution.
Key Result Areas
- Client Retention at 100%.
- Claims life cycle lead time at 25–30 days (simple claims) or 90–180 days (complex claims).
- 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%.
- 100% compliance with processes, policies, and procedures.
Required Skills and Competencies
- Knowledge of various insurance products, claim processes, and handling general insurance products.
- At least 3 years of experience in a busy general insurance claims environment.
- Excellent communication skills in both verbal and written English.
- Strong analytical and risk management capabilities.
- Excellent computer skills.
- Good organizational skills, agility, resourcefulness, and collaborative mindset.
- Solution-oriented problem solver and strong team player.
- Negotiation skills, interpersonal skills, and high attention to detail.
Professional and Academic Qualifications
- Bachelor's Degree from a recognized university in a Business or Legal Studies-related discipline.
- Diploma in ACII / AIIK.
