Job Purpose and Key Responsibilitie
Job Purpose:
Assist in processing and payment of individual life claims and benefits
Key responsibilities:
- Registration of all new claims promptly and acknowledging receipt of the same.
- Processing and payment of Individual life, Group Life, Retrenchment, NHIF and Credit Life claims and benefits.
- Assembling and analyzing claims to establish liability.
- Monitor and ensure that the key interfaces adhere to the set claims handling standards and escalate non adherence to the management.
- Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
- Respond to both internal claims inquiries concerning benefits, claims process, service providers, and the filing/completion of proper forms.
- Record all claims transactions and maintain accurate claims registers.
- Continuously review of claim accruals to minimize claim reserves.
- Audit and reporting on potential Unclaimed Assets set to be registered with UFAA.
- Capture and maintain accurate data to ensure data integrity.
- Ensure compliance with all regulations.
- Handling customer queries & correspondence on individual life policies to enhance seamless customer experience.
- Prepare claims management reports on a monthly basis or as otherwise advised.
- Facilitating the process of Group & Credit scheme renewals.
- Follow through to ensure all claims with issues at registration level have been addressed or escalated for action.
- Ensure that all claim documents received for Group & Credit Life claims are uploaded and indexed to Document Management System.
- Vetting and analyzing Group & Credit claims as per scope of cover whilst ensuring strict adherence to set guidelines and TAT.
- Monthly tracking of insured reimbursement claims with respective underwriters for payment.
- Reconciliation of reimbursement claims and ensuring all the claims are paid within the agreed TAT.
- Perform daily (or weekly) reconciliations and reviews for both financial transactions and LoB Systems.
- Monthly Quality Assurance assessments.
- Notify brokers and clients of pended and declined claims within set timelines.
- Prepare executive presentations and reports to facilitate project evaluation and process improvement.
- Adhere to claims manual procedures and process.
Knowledge, experience and qualifications required
Knowledge, experience and qualifications required:
- Bachelor’s degree in commerce, Insurance option or equivalent.
- At least one year experience in claims processing.
- Professional qualification in Insurance i.e. (ACII, FLMI or IIK)
- Attention to detail.
