JOB DETAILS:
Job Description
• Registering all claims as they come in for processing.
• Investigating the nature of the claims where necessary and determining  insurance policy coverage and reserving.

• Working closely with the other team members including legal consultants and escalating matters as appropriate within timelines.
• Maintenance of proper records with details of the claims processed, paid and outstanding.

• Providing weekly and monthly claims reports for management consideration.
• Notification to Reinsurance Officer in respect to recoveries.

• Follow up to obtain full documentation pertaining claims

• Follow up of all claims to ensure timely payments

• Follow up of Discharge vouchers sent to corporate clients
• Coordinate review meetings with both clients and company to monitor services

• Undertake any other duties as required commensurate with the level of the position

Knowledge And Experience.
Qualifications:
A bachelor’s degree in actuarial science or any business-related courses. Professional qualifications such as ANZIF, ACII, DIP CII, AIA will be an added advantage.
Experience:
• 5 years’ work experience in underwriting and claims.
• Practical knowledge of life Assurance business functions and operations and awareness of relationships between functional areas of operation.

• Ability to work efficiently and methodically to effectively manage caseload and use own initiative.
• A willingness and ability to learn given that the law changes over time and keeping abreast of new case law and groundbreaking decisions that give the company an advantage when defending claims.
Handles a variety of coverage with a defined loss potential. Reviews and proceses claims of low to moderate face value or liability against policies and coverage information. Decision-making is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subject-matter experts for additional data. Settles and negotiates claims within authorised authority.

Responsibilities
•  Insurance Claims Administration
• Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.
• Insurance Claims Evaluation
• Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.
• Fraud/Financial Crime Investigation
• Carry out assigned information and evidence-gathering activities to support the investigation of cases of suspected fraud or financial crime and the instigation of criminal investigations and/or legal actions.
• Fraud/Financial Crime Management
• Use established prevention models, systems, and protocols to monitor client or customer activities or transactions, informing more senior colleagues about suspicious activities.
• Operations Management
• Provide operational support by performing a range of routine activities using existing systems and protocols.
• Solutions Analysis
• Find the most effective ways to respond to routine functional inquiries. Involves following procedures and precedents.
• Document Preparation
• Prepare moderately complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for reports.
• Resolving Customer Issues
• Respond to basic issue escalations promptly and appropriately; provide managerial approvals as required.
• Regulatory and Compliance Management
• Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.
• Operational Compliance
• Develop knowledge and understanding of the organization's policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.
• Personal Capability Building
• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

Skills
• Analytical Thinking, Coaching, Codes of Conduct, Compliance Monitoring, Customer Service, Customer Service Standards, Decision Making, Development Planning, Exercises Judgment, Insurance Claims, Insurance Coverage, Legal Practices, Negotiation, Operations Support, People Management, Planning Activities, Regulatory Requirements, Service Standards, Summarizing Data
• Competencies
• Action Oriented
• Collaborates
• Drives Results
• Ensures Accountability
• Financial Acumen
• Instills Trust
• Manages Complexity
• Optimizes Work Processes
• Education
• Bachelors Degree (B): Actuarial Science (Required)