About the Role:

The Claims Lead role is part of our Customer Operations team. The ideal candidate will oversee and optimize our claims processes, ensuring efficiency, accuracy, and the prevention of fraudulent activities. This role requires a solid understanding of insurance claims, particularly in the medical field, along with the ability to collaborate effectively with both internal and external stakeholders.

Key Roles and Responsibilities

Process Optimisation

• Review sample claims to identify areas for process improvement, aiming to enhance efficiency and reduce turnaround times.
• Recommend and implement updates to claims processing procedures based on analysis and best practices.

Fraud Detection and Prevention

• Actively review claims to identify potential fraud attempts and initiate thorough investigations.
• Develop and implement process improvements to strengthen fraud control measures.

Blacklisting Management

• Create and implement methods for blacklisting and banning facilities, service providers, and professionals involved in insurance claims fraud.
• Establish a process for periodic review and potential removal from blacklists based on established criteria.

Claims Relationship Management

• Provide comprehensive support to partners, ensuring they understand claims processes and the necessary customer information for smooth processing.
• Serve as a primary point of contact for partners regarding claims-related inquiries.
• Work closely with underwriters to determine Service Level Agreements (SLAs), and KYC for claims processing.
• Act as the go-to person for customer support teams in our markets on all matters related to insurance claims.
• Provide expert guidance and support to resolve complex claims issues.

Reporting and Analysis

• Generate findings on claims trends, fraud detection, and process improvements, and participate in the creation of new claims review methods
• Analyze data to identify areas for improvement and implement effective solutions.

Key Qualifications:

• Live Turaco’s values – Push boundaries, Work with excellence, and Profound respect for the individual
• 3 to 5 years of experience in Insurance, particularly claims analysis.
• Bachelor’s degree qualification in Finance/Insurance or a related field is required.
• Additional insurance professional qualification (e.g., CoP, DIP) is a significant plus.
• Strong knowledge of and experience with Microsoft Office Tools, Insurance CRMs and Data Analysis tools.
• Understanding of Insurance terminology and how it is applied to daily work.
• Proven experience in handling medical-related insurance claims is highly preferred.
• Sound interpersonal skills and communication skills.
• Ability to work autonomously and take initiative; demonstrate self-motivation and energy, work well under pressure, and meet tight deadlines.
• Willingness to work as a team member with people across geographies and cultures.