JOB DETAILS:
Job Purpose:
Claims Processing
• Receive, register, and acknowledge claims from clients and intermediaries.
• Verify submitted claims documents for completeness and accuracy.

• Capture claims details into the claims management system promptly.

Claims Assessment and Documentation
• Assist in assessing the validity of claims by cross-referencing policy terms and conditions.
• Ensure all supporting documents such as police reports, medical reports, or repair estimates are collected and recorded.

• Liaise with service providers (e.g., garages, hospitals) to verify claims information and costs.

• Carry out a thorough claims review process to ensure our reserves are up to date
• Maintain low loss ratios through thorough negotiations and assessments

Claims Settlement
• Follow up on claims approvals and payments within the stipulated timelines.
• Assist in resolving discrepancies or issues arising from claims processing.

• Prepare claims payment requests and ensure accurate records of payments made.

Customer Service
• Communicate with claimants and brokers to provide updates on the status of claims.
• Address and escalate client complaints or queries in a timely manner.
• Provide guidance to clients on claims submission requirements and procedures.

Compliance and Reporting
• Maintain proper filing of claims records for reference and audit purposes.
• Ensure all claims are processed in compliance with company policies, insurance regulations, and service-level agreements.

• Generate and submit periodic claims reports to the Claims Officer.

Collaboration and Teamwork
• Coordinate with underwriting, risk assessment, and legal teams on claims-related matters.
• Work closely with external assessors, surveyors, and investigators to facilitate claims processing.

• Support other team members during high workloads or tight deadlines.

Risk and Fraud Management
• Highlight suspicious or fraudulent claims to the Claims Officer for investigation.
• Assist in implementing controls to mitigate claims fraud risks.

Reinsurance Claims Recoveries and Third-Party recoveries
• Communicate with reinsurers to notify them of claims and initiate the recovery process.
• Provide documentation for all reinsurance related claims to the reinsurers
• Follow up on reinsurance debt to monitor the status of reinsurance claims
• Provide regular updates and reports on recovery status, including any delays
• Work closely with claims, underwriting, finance and legal departments to ensure smooth reinsurance and third-party recovery process
• Ensure all documents and files related to third party recoveries are up to date with regular reporting.

Continuous Improvement
• Contribute to process improvements to enhance efficiency and customer satisfaction in claims handling.
• Stay updated on industry trends, regulatory changes, and claims management best practices.

Key Performance Measures:
• Loss ratio
• Timely collected Reinsurance recoveries
• Superior customer experience
• Claims Turnaround Time
100% fraud lockout

Knowledge, experience and qualifications required
Knowledge & Skills:
• Understanding of insurance principles, claims handling processes, and policy terms.
• Familiarity with Uganda’s insurance regulatory framework and industry best practices.

• Strong analytical and problem-solving skills to assess and validate claims.
• Attention to detail and accuracy in reviewing claim documentation and processing payments.
• Proficiency in Microsoft Office applications (Word, Excel, Outlook) and claims management systems.
• Strong communication and interpersonal skills for engaging with clients, brokers, service providers, and internal teams.
• Ability to work under pressure, meet deadlines, and manage multiple claims simultaneously.
• Customer service orientation with a focus on delivering excellent client experiences.

Experience:
• 1–2 years of experience in claims processing, underwriting, or a related role in the insurance industry.
• Experience handling general insurance claims is an added advantage.
• Previous experience working with brokers, loss adjusters, or service providers is beneficial.

Qualifications:
• A bachelor’s degree in Insurance, Business Administration, Actuarial Science, Law, or a related field.
• Professional certification in Insurance (Certificate or Diploma) is an added advantage.