Claims Analyst at NCBA Group

Job Purpose Statement

To analyze and process claims efficiently in accordance with insurance contract terms and established company policies and standards. The role focuses on verifying claims, analyzing claims 
data, determining entitlements, validating claim legitimacy, negotiating settlements, and adhering to NCBA Insurance’s Claims best practices to ensure timely and efficient claims processing

Key Accountabilities (Duties and Responsibilities)
Claims Management 

• Assist in processing claims accurately and in a timely manner as per agreed Service Level Agreements.
• Assist in reviewing documents and pertinent requirements regarding an insurance claim to establish liability.
• Assist in advising claimants on basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claim-related inquiries.
• Review files for continuing adequacy of reserves under the guidance of the claims manager.
• Review all files for Key Fraud Indicators and refer identified cases to the Special Investigation Unit.
• Assist in initiating recovery and refer such matters to the subrogation officer.
• Assist in initiating claims payment to policyholders as per NCBA Insurance’s service level agreements.
• Maintain active diary system for all active files and provide regular updates to customers
• Capture and maintain accurate data to ensure data integrity.
• Archive all claims correspondences in core system for future reference.

Operational/Compliance 

• Adhere to internal Service Level Agreements and Claims Quality Assurance requirements to ensure operational efficiency and achievement of agreed service standards.
• UpholdEnsure adherence to audit requirements.
• Ensure adherence to regulatory and compliance requirements.

Customer Service

• Focus on providing delightful customer service and explain to them any areas that are not understood.
• Educate the customer on the claims engagement and ensure customer fully understands the process.
• Follow up on customer feedback and action appropriately