We are looking for motivated and qualified professionals to fill the position of Claims Officer (Negotiation).
Overall Purpose of the Job: The Claims Officer (Negotiation) is responsible for negotiations and out of court settlement of claims.
Key Roles and Responsibilities
a) Conduct thorough and detailed analysis of claim documents to enable early fraud detection and to effectively address the fraudulent claims within the company’s policies and guidelines.
b) Ensure that injury verification and investigations instructions are issued within 48 hours after receipt of claim documents or new incident files. All relevant claim documents – under investigation must be attached to each instruction.
c) Liaise with the investigation department in order to follow up on the pending reports.
d) Review the investigation reports to ensure that all the information requested or that is required has been given and rejecting/reissuing the instruction of the same if it is incomplete or does not address the issues raised in the instructions.
e) Obtain adequate evidence through the investigators to ensure that fraudulent claims are dismissed in court. The information should be obtained prior to the claim turning legal.
Injuries verification and medical re-examinations
f) Liaise with the medical department, towards ensuring prompt booking of claimants for re-examination and follow up on medical reports.
g) Obtain interpretation of complex injuries and drugs administered from the medical department through a nurse’s summary.
h) Ensure that the injuries, treatment and medication given relate to road traffic accidents.
i) Follow up on reports from specialized doctors when the claimant is referred to them by the medical department
j) Ensure the medical reports are correct, and that the required verification of injuries has been properly done and documented. Rejecting incomplete medical reports
Claims and incidents management
k) Ensure that data is accurately and efficiently updated in the claims system resulting in the system data being a reflection of the physical file through proper update of the system data of the claims and incidents. The data should be updated within 24 hours of receiving claim or incident documents.
l) Follow up on collection of policy excess from the insured and intermediaries
m) Ensure that review of claims and incident files fully comprehensive and completed within the set timelines.
n) Maintain proper and accurate reserves on claims and incidents, and ensure the relevant Journal Vouchers are presented for Approval within 24 hours of receipt of any additional information.
o) Ensure full documentation of claims and incident files by following up the insured, claimant or his advocate for any outstanding documents.
p) Prepare the liability analysis and obtaining approval on the same within 48 hours of the investigation report being received.
q) Issue instructions to the Company’s advocates when matters turn legal.
r) Pursue any due recoveries from the insured and third parties, and ensuring that insured or his employee supplies all the requisite documents required to successfully pursue the recovery.
s) Conduct proper factual and legal research required for achievement of the strategy on the claims.
t) Engage with third party service providers where necessary to build evidence on liability, medical injury disputes etc.
u) Ensure timely preparation of claims files for negotiation or defence.
v) Settle genuine claims prior to the claimant or third party advocate pursuing compensation through the courts.
w) Prepare monthly claim reports for internal and external use and any other periodical reports as may be directed.
x) Address enquiries in the interpretation of the policy document.
y) Monitor changes in relevant legislation and the regulatory environment, and advising the company on the impact of such changes.
z) Attend court to represent the company as a witness or any other capacity as may be approved by the Company.
aa) Maintain highest level confidentiality concerning the sensitive, strategic and integral legal and other information, data, decisions and developments taking place at the company.
bb) Participate in and offer valuable advice to the Company and Departmental Committees which you are nominated or elected to.
Any other duty that may be assigned from time to time.
- University degree from an institution recognized by Commission for Higher Education
- Minimum Overall Grade of C+ in KCSE
- Certificate of Insurance (COP)
- AIIK Diploma/CII Diploma or any insurance related qualification will be an added advantage
- At least 2 years’ experience in Claims management preferably within an Insurance Company OR Intermediary.
- Experience in dealing with PSV will be an added advantage.
Skills and Attributes
- High level of integrity; Able to maintain utmost confidentiality of information in their possession
- Excellent communication and presentation skills
- Excellent interpersonal and negotiation skills
- Excellent Client relationship skills
- Have great attention to detail
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 email@example.com to reach us on or before 5.00pm Wednesday 19th September, 2018.