Senior Claims Officer at APA Life Assurance Company Ltd

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