Senior Claims Officer at Britam

Job Purpose: 

• The Senior Claims Officer role is responsible Ensuring that claims are accurately assessed, processed and paid in accordance with company regulations and standards, through processing, review and approval of claims and provision of guidelines and direction to the staff in the claims sub-sections. 
• The role holder is responsible for reviewing clients’ claims and insurance policies, determining eligibility & validity of claims and processing claim payments within the stipulated Turn Around Times (TATs).
• The role is responsible for a deeper interrogation of life insurance claims to ensure accuracy and adjudicate claim terms and conditions in compliance with organization’s claims guidelines, processes and procedures and ensure there is effective communication with policy holders, beneficiaries and/or claimants.

Key responsibilities:

• Ensuring customer claims and benefits are handled in a prompt, fair and efficient manner and in accordance with various policy terms and conditions and claims guidelines.
• Authorizing and approving various payments within set limits.
• Continuously monitor turnaround time of claims and benefits settlement and take or suggest corrective measures where there are gaps in claim process.
• Ensure maintenance of proper and accurate records in the sub-section.
• Generate accurate and timely reports to guide Management in decision making.
• Preparation of weekly and monthly claims reports.
• Portfolio analysis and risk recommendation reporting to underwriting department.
• Participate in review of claim reserves.
• Oversee the preparation of claims statistical reports within the stipulated time.
• Ensuring timely and accurate registration of all new claims and subsequent acknowledgement of the same as well as maintaining accurate claims registers.
• Accurate and timely processing and payment of Individual life, Group Life, Retrenchment, Credit Life claims and benefits.
• Analyzing claims to establish liability and subsequently approving the claims.
• Monitor and ensure that the key interfaces adhere to the set claims handling standards and escalate non adherence to the management.
• Ensure claimants are advised regarding basic matters about their insurance coverage in relation to the insurance claims.
• Respond to internal claims inquiries concerning benefits, claims process, service providers, and the filing/completion of proper forms in accordance to laid down procedures and within the confines of data protection act (2019).
• Continuous review of claim accruals to minimize claim reserves and ensuring there is timely and effective coordination of customer follow-ups with the various support/shared functions and maintenance of an up-to-date accruals action plan tracker. 
• Audit and reporting on potential Unclaimed Assets set to be registered with UFAA and ensuring there is timely and effective coordination of customer follow-ups with the various support/shared functions and maintenance of an up-to-date UFAA action plan tracker. 
• Capture and maintain accurate data to ensure data integrity relating to all claims.
• Ensure compliance with all regulations and guidelines relating to life insurance and claims administration.
• Prepare accurate claims management reports on daily, weekly and monthly basis or as otherwise advised.
• Follow through to ensure all claims with issues at all levels have been escalated and resolved conclusively and maintaining a tracker for the same. 
• Ensure that all claim documents received for Group & Credit Life claims are uploaded and indexed to Document Management System in a timely manner. 
• Vetting and analyzing Group & Credit claims as per scope of cover whilst ensuring strict adherence to set claims guidelines and TAT.
• Follow-up of claims recoveries with respective underwriters/co-insurers/facultative reinsurers for timely reimbursements.
• Reconciliation of reimbursement claims and ensuring all the claims are paid within the agreed TAT and penalties applied where applicable.
• Perform daily (or weekly) reconciliations and reviews for both financial and on financial transactions on LoB Systems, self-service platforms, ERP and other payment platforms as may be the case.
• Daily, weekly & monthly Quality Assurance assessments.
• Notify brokers or clients or the consortium or the implementation committee of pending, relisted and declined claims within set timelines.
• Ensuring On-Time, On-Budget and On-Quality Delivery of Projects for claims modules within life business.
• Project Prepare executive presentations and reports to facilitate project evaluation and process improvement.
• Ensuring there are adequate controls for all self-service platforms in order to safeguard customer benefits. 
• Adherence to all audit, risk and compliance guidelines. 
• Adhere to claims manual procedures and process.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Scorecard.

Knowledge, experience and qualifications required

• Bachelors of Commerce degree (insurance and/or statistical options preferred).
• Professional qualification in Insurance (ACII or AIIK).
• 3-5 years’ experience in insurance claims processing two of which must be in a supervisory position.
• Knowledge and experience in the insurance sector.

Technical/ Functional competencies:

• Knowledge of insurance concepts.
• Knowledge of Life insurance claims processes and procedures.
•  Knowledge of insurance regulatory requirements.