Role Purpose

• The role holder is responsible for processing claims and benefits efficiently and accurately, ensuring compliance with company policies, industry regulations, and exceptional customer service standards. The role requires collaboration with various stakeholders to assess claims and benefits, verify documentation, and resolve issues promptly to deliver a seamless experience for policyholders.

Main Responsibilities

• Process Claims: Review and validate claims documentation for accuracy and completeness. Assess claims in line with policy terms, conditions, and exclusions , and highlight any fraudulent claims.
• Benefit Administration: Administer various benefits such as death benefits, disability benefits, retirement benefits, and other relevant policy provisions, ensuring compliance with company policies and regulatory requirements.
• Documentation Management: Maintain accurate and organized claim and benefits documentation, including records of policyholders, beneficiaries, and relevant correspondence.
• Customer Service: Respond to inquiries and provide assistance to policyholders, beneficiaries, and internal stakeholders regarding claims, benefits, and policy-related matters.
• Payment Processing: Collaborate with the finance department to ensure prompt and accurate processing of claim payments and benefit disbursements.
• Compliance and Audit: Adhere to internal procedures, regulatory guidelines, and industry best practices to ensure compliance and participate in internal and external audits when required. Recommend risk management techniques and controls based on claims experience.
• Reporting: Prepare reports and maintain data related to claims and benefits activities, including claims settlement ratios, turnaround times, and other relevant metrics.
• Continuous Improvement: Identify areas for process improvement, propose solutions, and actively participate in implementing enhancements to streamline claims and benefits operations.
• Projects:; Support projects from time to time as allocated

Key Competencies

• Attention to Detail: Ability to carefully review and analyze claim applications, documentation, and policy provisions to ensure accuracy and compliance.
• Customer Focus: Strong customer service orientation with excellent communication and interpersonal skills to effectively address customer inquiries and concerns.
• Analytical Thinking: Capacity to evaluate claim information, assess eligibility, and make sound decisions based on available data and policy terms.
• Problem Solving: Aptitude for identifying and resolving issues or discrepancies in claims and benefits processes.
• Time Management: Effective prioritization and ability to meet deadlines in a fast-paced environment.
• Teamwork: Collaboration with cross-functional teams, including underwriters, actuaries, and finance personnel, to facilitate smooth claims and benefits operations.
• Adaptability: Flexibility to adapt to changing business needs, policies, and industry regulations.

Qualifications

• Bachelor’s degree in actuarial science, Statistics, Insurance or Finance.
• IT proficiency (especially excellent command in MS Word, Excel, PowerPoint and Outlook)
• Professional certifications in insurance would be an added advantage.

Relevant Experience

• At least 2-3 years’ experience in a similar role.
• Knowledge of legislation governing Retirement Benefits and Insurance in Kenya will be an added advantage.