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.
Claims Manager Jobs Responsibilities
In liaison with the MD formulating and monitoring the claims Department strategic plans
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
Build a supportive, team-orientated environment for the staff through embodying a sense of empowerment, demonstrating positive thinking and establishing common goals and interdependence with the employees.
Ensure in-depth, investigation of actual claims through direct or indirect contact with policyholders, claimants, other carriers, physicians, contractors, attorneys 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 timely to reinsurance as required by procedure.
Co-ordinate and maintain expeditious and efficient processing of claims and ensure customer needs are attended to promptly.
Ensure compliance with statutory regulatory bodies
Prepare annual budget for the department and ensure proper budgetary control.
Analyse claims data to identify issues, and ensure that all relevant issues relating to underwriting policies, re-insurance arrangements, and product pricing are identified andcommunicated to relevant manager.
Set standards (benchmarks) for measuring the performance of strategic customer relationship and communication.
Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures.
Confer with legal counsel on claims requiring litigation.
Develop tools and recommendations for risk management / fraud detection
Ensure that all claims fall within scope of respective insurance policy.
Coordinating the preparation of weekly claims statistics.
Control administrative costs through effective budgeting, appropriate staffing and close monitoring of ongoing expense allocations.
Identify, appoint and maintain an efficient and effective evaluation of service providers.
Prepare periodical claims report and other management reports relating to claims and ensure that remedial action is taken promptly
Set reserves on files and distributed reserve and settlement authority to claims staff within corporate guidelines.
Any other duties that may be assigned by the MD from time to time.
Qualifications for the Claim Manager Job
A bachelor’s degree from a recognized University.
A diploma in Insurance (ACII, AIIK or equivalent)
Master’s Degree
8 years’ relevant working experience, four (4) of which should have been at Section Head level or above
Analytical Thinking
Customer orientation
Holding People accountable
Leadership and developing others
Relationship building for influence
Team working
Innovation
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