Open Roles at Directline Assurance Company Limited

Key Responsibilities

Cost Management

• Assist the Head of Firm in effectively managing the budget allocated to the Law Firm and to ensure that the claim expenses are within the Client’s guidelines.
• Manage the allocated legal files stock and ensure that the targets set by the Law Firm on settlement of claims and closure of files is achieved within the set timelines.

Claim Investigations and Verification

• Conduct a thorough and detailed analysis of claim documents to enable early fraud detection, and effectively address the fraudulent claims to meet the client’s guidelines.
• Analyze the investigations reports to ensure that all relevant information is captured and to reject incomplete reports or reissue the instructions
• Obtain adequate evidence on liability and fraud from the client’s investigators to ensure that fraudulent/liability claims are dismissed in court.
• Liaise with the client’s Investigation and Medical Departments to ensure claim investigation/verification reports and medical re-examinations are promptly completed.

Court Attendance and Preparation

• Conduct proper and factual legal research required for achievement of the defence or settlement strategy on the legal files.
• Timely attendance in court or tribunals to effectively represent the interests of the client within the approved defence/settlement strategy and while so doing maintain the highest level of integrity and professionalism.
• Perusal of Court proceedings, Rulings and Judgments and/or co-coordinating the perusal and obtaining of copies of such Rulings, Proceedings, Rulings and judgments

Pleadings and File Management

• Proper management the legal files in line with the guidelines established by the client and ensuring that instructions are executed in a timely and efficient manner to protect the interests of the client.
• Ensure proper documentation of the legal file and data accuracy through timely completion of periodical file reviews.
• The data must be accurately and efficiently updated in the system resulting in the system and be an accurate reflection of the physical file within 48 hours of after receiving new information or documents that necessitates the change.

General Duties

• Monitor changes in relevant legislation and the regulatory environment, and advise the client on the impact of such changes.
• Maintain a good rapport with the third party advocates, courts and other service providers dealing with the Law Firm.
• Any other duties that maybe assigned from time to time in the discharge of the Law Firms obligations under this agreement.

Candidates should meet the following minimum qualifications:

• Advocate of the High Court of Kenya Have at least two (2) years of post-admission litigation experience in a busy law firm. Have a current Practicing Certificate.
• Be computer literate. Be of high integrity. Have good communication, presentation, research and analytical skills.
• Have excellent organizational and interpersonal skills and be able to work in a team.
• Have the ability to handle pressure and work with minimum supervision.
• Ability to develop positive relationship with clients & manage client expectations;
• High quality research skills and drafting skills;
• High level of accuracy and attention to detail; Knowledge of legal document filing procedures in the relevant registries;

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OVERALL PURPOSE OF THE JOB

• The role holder will be based in the Investigations Department and will support the doctor(s) in the analysis of medical claims arising from road traffic accidents. The individual will also play a key role in providing second medical opinions on the nature and extent of injuries sustained.

KEY ROLES AND RESPONSIBILITIES

• Research and report writing pertaining to the confirmation of diagnosis made and treatments administered with claims and reporting on the same.
• Submission of authenticated reports
• Authentication, Analysis, Interpretation and verification of medical treatment records pertaining to accident claims.
• Identification of inconsistency between police and hospital records
• Responsible for highlighting misdiagnosis and/ or irregular medical records.
• Preparation of medical reports and statistics.
• Understanding of medical health facility procedures and medical records.
• Re-examination of road traffic accident victims in order to provide a second opinion.
• Any other responsibilities will be communicated to the Officer from time to time
• Giving intelligence of fraud perpetrated in medical facilities
• Identify and report fraudulent activities and fraudsters within the medical facilities

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s Degree in Nursing or its equivalent from a recognized institution KRCHN/KRN-Diploma in Nursing Professional Qualifications KRCHN Registered with Nursing Council of Kenya and must possess a valid license Member of a relevant professional body

Experience

• Must have at least two (2) years’ working experience in a busy hospital facility.
• Working experience in the insurance industry is an added advantage.

Skills and Attributes

• Kenya recruitment agency Basic MS office skills
• Strong interpersonal, communication and negotiation skills
• Superior analytical and report writing skills.
• High moral and ethical standards with independence of mind and ability to defend his/her position on significant issues.
• Excellent word processing and IT skills, Ability to work under pressure and meet tight deadlines
• Good organisational and time management skills
• Ability to research, digest, analyse and present material clearly and concisely
• Ability to take initiative and pay attention to detail High level of integrity and reliability
• Flexibility and adaptability to juggle a range of different tasks and to work extra hours to meet deadlines.
• Discretion and an understanding of confidentiality issues