KEY PRIMARY RESPONSIBILITIES
Claims handling
Assess – Assess the claim’s validity.
Claims Bookings – Record all valid claims in the claims register and in Life Management System (LMS)
Acknowledge valid claims reported and request required claims documents.
Assess claim documents, initiate claim payments, and assign claims tickets for approval.
Approve claims as per approval of the mandate.
Follow up on claims payments and transmission/inform customers of progress.
Review outstanding claims and follow up on outstanding documents. Review claims documents submitted and made claims recommendations.
Review suspicious claims and make recommendations for investigations.
Review investigation reports and make recommendations.
Adhere to IRA and company claims guidelines.
Compliance
Prepare Compliance Reports for IRA, AKI, etc.
Provide data and claims files to both Internal & External Auditors
Work with the Risk Manager and provide data and files.
Customer Services
Handle claim complaints, register, and ensure resolution.
Handle appeals for declined claims, prepare file notes, or organize claim team meetings.
Handle incoming calls, record and resolve client issues or escalate to the supervisor.
Attend to the walk-in clients and brokers.
Client and Brokers engagements – Plan & Perform client and brokers visits.
Work with the customer service team when required.
Product & Processes
Capture LMS gaps and escalate to the ICT team for resolution.
Review process manual
Design claims forms and documents for new products
Attend all process meetings and provide input to improve processes.
Attend all product meetings and provide input.
Participate fully in all quality processes improvement, including ISO.
Prepare and submit reinsurance cessions for claims recoveries.
Provide reports on claims recoveries Train new staff on claim processes and procedures.
Train clients and Brokers on claims processes and procedures
ACADEMIC QUALIFICATIONS
Business Related Degree preferably in Insurance/Actuarial Science.
JOB SKILLS AND REQUIREMENTS
Communication and Interpersonal skills
Time management skills
Team player
Analytical skills
Problem-solving skills Negotiation
Leadership skills
PROFESSIONAL QUALIFICATIONS
Diploma in Insurance, AIIK/ACII
EXPERIENCE
At least 5 years of relevant experience
Apply via :
apollogrouprec.peopleshr.com
