Kenya Orient Insurance Limited
Job Title: Head of Claims
Reporting to: GM Operations
Purpose of the role: 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
Internal profile: Claims
Directly manages / supervises: Claims Department
Key tasks and responsibilities
- 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
- 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
- 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.
- 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.
How to Apply
If you are interested in the position and have the required qualifications, skills and experience, kindly CLICK HERE and apply on or before Monday, June 10th, 2019.