Lawyer – Insurance Claims at Africa Management Solutions Limited (AMSOL)

Job Purpose

• The Lawyer – Insurance Claims will be responsible for reviewing, assessing, and resolving insurance claims from a legal perspective while minimizing legal exposure and ensuring efficient claims handling. The role involves providing legal advisory services, supporting litigation management, negotiating settlements, detecting fraudulent claims, and maintaining compliance with legal and regulatory frameworks.

Key Responsibilities

Insurance Claims Management

• Review insurance claims to determine legal liability, policy coverage, and admissibility.
• Examine claim documents, including insurance policies, police abstracts, medical reports, investigation reports, accident reports, court pleadings, demand letters, and supporting evidence.
• Assess claims based on policy terms, legal principles, and regulatory requirements.
• Provide recommendations on claim approval, repudiation, or partial settlement.

Legal Advisory

• Provide legal opinions on liability, negligence, policy interpretation, fraud indicators, limitation periods, and claim exposure.
• Interpret insurance contracts, policy endorsements, exclusions, warranties, and conditions.
• Advise management and claims teams on legal risks and appropriate claims handling strategies.
• Ensure claims decisions are legally sound and commercially appropriate.

Litigation & Dispute Resolution

• Manage claims that progress to litigation, arbitration, mediation, or other dispute resolution mechanisms.
• Liaise with external advocates and monitor court proceedings.
• Review pleadings, witness statements, legal correspondence, consent agreements, and court filings.
• Maintain an updated litigation tracker and monitor case progress.
• Recommend settlement, defense, or appeal strategies where appropriate.

Negotiation & Claims Settlement

• Participate in negotiations with claimants, advocates, insurers, brokers, and third parties.
• Assess settlement proposals and provide legal recommendations.
• Ensure settlement agreements are properly documented and approved.
• Support timely and cost-effective dispute resolution.

Documentation & Regulatory Compliance

• Maintain accurate legal files, claims records, correspondence, legal opinions, settlement agreements, and court documentation.
• Ensure compliance with insurance legislation, data protection laws, and internal company policies.
• Support audit and regulatory compliance requirements.

Fraud Detection & Risk Management

• Identify potentially fraudulent, exaggerated, or suspicious claims.
• Analyze inconsistencies within claims documentation and supporting evidence.
• Recommend investigations and legal action where necessary.
• Support initiatives aimed at reducing fraud and minimizing claims-related risks.

Stakeholder Management

• Work closely with Claims Officers, Underwriters, Insurers, Brokers, Loss Adjusters, Investigators, Medical Providers, External Advocates, Claimants, and Regulatory Authorities.
• Maintain professional communication and ensure timely follow-up on all legal and claims-related matters.
• Foster collaborative working relationships to facilitate efficient claims resolution.

Qualifications & Experience

Must-Have

• Bachelor of Laws (LL.B) degree from a recognized university.
• Postgraduate Diploma in Law from the Kenya School of Law.
• Admission to the Roll of Advocates of the High Court of Kenya will be an added advantage.
• Minimum of 1–3 years' experience in insurance claims, insurance litigation, personal injury, motor claims, medical claims, or general insurance claims management.
• Experience working in an insurance company, insurance brokerage, claims management firm, law firm, or similar environment is highly desirable.

Required Skills & Competencies

• Strong understanding of insurance law and claims management processes.
• Excellent knowledge of insurance policy interpretation and litigation procedures.
• Legal research, drafting, and analytical skills.
• Strong negotiation and dispute resolution abilities.
• Excellent communication and interpersonal skills.
• High level of integrity, professionalism, and confidentiality.
• Strong organizational and time management skills.
• Ability to manage multiple claims while meeting strict deadlines.
• Proficiency in Microsoft Office applications and legal documentation systems.

Key Performance Indicators (KPIs)

• Timely legal review and assessment of insurance claims.
• Accuracy and quality of legal opinions and recommendations.
• Effective management of litigation and dispute resolution matters.
• Reduction in legal exposure and claims-related losses.
• Timely follow-up with advocates, insurers, and relevant stakeholders.
• Proper maintenance of legal and claims documentation.
• Successful negotiation and settlement of claims within approved timelines.

​​​​​​​​​​​​​​​​​​​​​Personal Attributes

• The ideal candidate should demonstrate:
• High ethical standards and professional integrity.
• Strong analytical thinking and sound legal judgment.
• Excellent attention to detail.
• Resilience and ability to work under pressure.
• Confidentiality and discretion when handling sensitive matters.
• A proactive, solution-oriented, and collaborative approach.