Vacancies at Old Mutual Kenya

Job Description

The Team Leader – Retail Claims is responsible for overseeing the end-to-end processing of retail life claims, ensuring timely adjudication, regulatory compliance, leading and motivating a team and high levels of customer satisfaction. The role provides technical guidance, quality control, and performance oversight to claims officers, while also handling escalated or complex claims directly. The position plays a key role in upholding trust in the claims process and strengthening customer loyalty.

 KEY TASKS AND RESPONSIBILITIES

• Supervise the assessment and processing of individual life claims, ensuring adherence to SLA, policy terms, and regulatory guidelines.
• Review high-value or complex claims and provide technical input on eligibility and documentation.
• Collaborate with medical providers, reinsurers, and internal stakeholders for effective claims resolution.
• Track and report claim trends and develop initiatives to manage service quality
• Lead initiatives to improve claims efficiency, reduce leakage, and mitigate operational risks
• Conduct regular team meetings, coaching and performance evaluations to direct reportees.
• Ensure all claims practices are aligned with the Anti-Money Laundering (AML) Act, the Data Protection Act (DPA), and Insurance Regulatory Authority (IRA) guidelines.
• Ensure screening and verification of claimants and beneficiaries, and escalate any red flags or fraud indicators in accordance with internal compliance policies

SKILLS AND COMPETENCIES

• Expertise in life claims assessment and policy interpretation.
• Strong team leadership and quality control skills.
• Empathy and customer orientation in sensitive claim situations.
• Analytical mindset and sound decision-making.
• Excellent communication and stakeholder management.
• Ability to work under tight deadlines and pressure

KNOWLEDGE & EXPERIENCE

• 5+ years’ experience in life claim's function, with 2+ years in a supervisory or lead role
• Strong knowledge of retail life products and systems

QUALIFICATIONS

• Bachelor’s degree in Commerce or a related field.
• Professional certification (e.g., AIIK, ACII, ALMI) preferred

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Job Description

Reviewing, analyzing, and processing insurance claims to determine their validity and ensure compliance with policy terms. This role involves verifying documentation, liaising with various stakeholders, and recommending claim settlements or repudiation. The position requires strong analytical skills, attention to detail, and a solid understanding of insurance policies and procedures.

KEY TASKS AND RESPONSIBILITIES

• Review and evaluate insurance claims for accuracy, completeness, and compliance with policy guidelines.
• Investigate claim details, including gathering supporting documentation and consulting with claimants, service providers, or third parties as needed.
• Determine the validity of claims and make recommendations for payment, denial, or further investigation.
• Calculate appropriate benefit amounts or reimbursements in accordance with policy terms and coverage.
• Communicate with policyholders or other parties to clarify information or resolve discrepancies.
• Document all claim decisions and correspondence in the claims management system.
• Monitor and manage claims through resolution, ensuring timely processing and follow-ups.
• Collaborate with other departments such as underwriting, legal, or customer service when necessary.
• Identify trends or irregularities in claims data that may indicate fraud or require escalation.
• Ensure compliance with regulatory requirements, industry standards, and internal policies.

SKILLS, KNOWLEDGE & COMPETENCIES

• Analytical mindset with a keen eye for detail and risk.
• Excellent communication and interpersonal skills.
• Strong organizational and time-management abilities.
• Strong claims processing acumen and policy interpretation skills.
• High level of integrity, discretion, and professionalism.
• Ability to handle sensitive and confidential information.

QUALIFICATIONS & EXPERIENCE

• Bachelor’s degree in Insurance, Actuarial Science, Business Administration, or a related field
• Progress towards certification in insurance (e.g., AIIK, ACII, or equivalent).
• Minimum of 3 years of experience in insurance claims processing.
• Strong knowledge of general insurance products and claim processing lifecycle.
• Familiarity with regulatory requirements and fraud detection techniques.