Claims Manager- Life at CIC Insurance

 About the Role

 Reporting to the Chief Executive Director, the Claims Manager – Life role will support the effective and efficient management of the life insurance claims function by ensuring accurate, timely, and fair assessment and settlement of claims; maintaining prudent and adequate reserving; ensuring full compliance with regulatory, policy, and governance requirements; and driving continuous improvement in claims processes, service delivery, and operational controls, while providing strong leadership, guidance, and professional development to the claims team.

PRIMARY RESPONSIBILITIES:

 Claims Approval & Settlement

• Provide technical oversight and approval of life insurance claims discharge documentation within delegated authority levels.
• Authorize payment of life claims strictly in line with policy provisions, underwriting intent, reinsurance requirements, regulatory rules, and internal governance frameworks.
• Ensure all life claims are assessed, approved, and settled accurately, fairly, and within agreed turnaround times (TATs).
• Exercise sound judgment to ensure settlements reflect policy intent while safeguarding the company against financial, legal, and reputational risk.
• Review and validate complex claims assessments to ensure alignment with medical evidence, legal documentation, underwriting disclosures, and contractual obligations.
• Escalate high‑risk, high‑value, complex, or contentious claims with comprehensive analysis, risk assessment, and clearly articulated recommendations.

 Claims Reserving & Review

• Establish, review, and adjust life claim reserves based on evolving claim facts, legal outcomes, and exposure assessments.
• Ensure reserves accurately reflect the ultimate liability and comply with actuarial input, accounting standards, and regulatory requirements.
• Monitor reserve adequacy and trends to minimise reserve volatility and financial misstatement.
• Conduct structured periodic reserve reviews, providing clear justification for material adjustments, strengthening overall portfolio transparency and control.
• Collaborate with actuarial and finance teams to enhance reserving accuracy and claims provisioning discipline.

Risk Management & Underwriting Support

• Analyse life claims experience, including mortality, morbidity, loss ratios, and emerging risk trends.
• Identify systemic issues, root causes, anti‑selection risks, and control gaps impacting portfolio performance.
• Provide targeted, data‑driven feedback to underwriting, pricing, and product teams to improve risk selection, pricing adequacy, and policy wording clarity.
• Support continuous enhancement of underwriting guidelines leveraging claims insights and lessons learned.
• Participate in post‑loss reviews, evaluations, investigations, and technical assessments.

Customer Service & Complaints Handling

• Champion fair and transparent claims handling in line with Treating Customers Fairly (TCF) principles.
• Manage escalated, sensitive, or complex claims complaints involving beneficiaries, policyholders, intermediaries, and regulators.
• Ensure professional, timely, and well‑documented communication at all stages of the claims journey.
• Build and maintain strong professional relationships with brokers, agents, reinsurers.
• Strengthen trust and brand reputation through balanced, customer‑centric, yet contractually sound decision‑making.

Regulatory, Governance & Management Reporting

• Prepare, validate, and submit accurate life claims returns and reports to the Insurance Regulatory Authority (IRA) within prescribed timelines.
• Ensure compliance with all statutory, regulatory, reinsurance, and internal reporting standards.
• Maintain high standards of data integrity, documentation quality, and audit readiness.
• Support internal, external, and regulatory audits by providing clear explanations, reconciliations, and corrective action plans.
• Produce insightful management reports highlighting claims performance, risk exposures, trends, operational efficiency, and emerging issues.

Appeals & Ex‑Gratia Claims Management

• Coordinate preparation and presentation of claim appeals and ex‑gratia requests to management, relevant or committees.
• Ensure all ex‑gratia settlements are justified, exceptional, fully documented, and aligned with approved governance frameworks.
• Track appeal outcomes and identify systemic lessons to enhance decision‑making consistency and reduce recurrence.
• Strengthen transparency and accountability in exceptional claims handling.

People Management & Development

• Provide strong leadership, supervision, and mentorship to life claims teams.
• Set performance standards aligned to quality, turnaround time, customer experience, and technical excellence.
• Conduct structured performance reviews and implement targeted development and succession plans.
• Allocate workloads effectively and monitor productivity to ensure service and quality benchmarks are consistently achieved.
• Foster a culture of professionalism, ethical conduct, accountability, collaboration, and continuous improvement.

Decision‑Making & Accountabilities

 Financial Impact Decisions

• Approve life claim payments within delegated authority limits.
• Provide expert technical input into declined, disputed, negotiated, appealed, and ex‑gratia claims.
• Influence claims cost containment, reserve adequacy, loss ratios, and overall product profitability.
• Contribute to life claims budgeting, forecasting, and expense management initiatives.

Operational, Customer & People Impact Decisions

• Communicate claim decisions clearly, professionally, and sensitively to policyholders, beneficiaries, and intermediaries.
• Drive continuous improvement of life claims processes, controls, systems, and workflows.
• Coach and guide staff to enhance technical competence and decision quality.
• Ensure consistent adherence to service standards, ethical principles, regulatory requirements, and internal policies.

Who We’re Looking For

Academic & Professional Qualifications

• Bachelor’s degree in actuarial, Business Administration or a related discipline.
• Professional insurance qualification such as ACII, CII, Diploma in Insurance
• Master’s Degree in related field is an added advantage.

 Experience

• Minimum of 8 years’ experience in claims Management.

 Key Competencies

• Claims Technical Expertise – Strong knowledge of policy interpretation, claims assessment, settlement, and reserving practices.
• Analytical & Judgment Skills – Ability to analyse complex claims, assess risk and quantum, and make sound, fair decisions.
• Decision-Making & Accountability – Confident, timely decision-making within delegated authority with clear ownership of outcomes.
• Customer & Stakeholder Management – Professional handling of customers, intermediaries, complaints, and external service providers.
• Leadership & People Development – Ability to coach, mentor, and manage claims staff to achieve performance and quality standards.
• Planning & Time Management – Strong organization and prioritization skills to meet turnaround times and service levels.
• Communication & Reporting – Clear written and verbal communication, including regulatory and management reporting.
• Ethics, Compliance & Integrity – Commitment to ethical conduct, regulatory compliance, and Treating Customers Fairly principles.