Senior Legal Claims Officer

Role Overview

This position sits within the legal claims unit and reports to the Assistant Manager of Legal Claims. The role is responsible for processing insurance claims from a legal perspective, making sure every claim file is complete, compliant, and properly documented before it moves forward. Day to day, the job involves reviewing claim submissions, coordinating with external advocates and service providers, tracking litigation and settlement progress, and keeping accurate registers so that claims are resolved efficiently and within regulatory and internal guidelines.

Key Responsibilities

• Review claim documents and supporting evidence to confirm that each submission meets the required standards and is ready for processing.
• Advise claimants and internal stakeholders on basic coverage questions, claims procedures, and the correct way to complete and file claim forms.
• Act as the point of contact for both internal and external queries about benefits, claims processes, appointed service providers, and documentation requirements.
• Maintain complete and up-to-date records of all claims transactions, including appointments of advocates, medical experts, and investigators, and ensure every assigned matter is tracked in the relevant registers.
• Prepare and update legal claims registers and claims reports for regular meetings, and follow up on appeal deposits until they are resolved.
• Provide input on legal issues arising from claims, compile detailed file notes for both court judgments and out-of-court resolutions, and assist with reserve reviews under the established reserving guidelines.
• Manage the panel of external advocates by maintaining proactive communication, reviewing their status updates, and checking their legal costs against service level agreements and the Advocates Remuneration Order.
• Process payments to insured parties and service providers, support third-party recovery efforts, and perform other claims-related duties as assigned.

Requirements & Qualifications

• Bachelor of Laws (LLB) degree and a Postgraduate Diploma from the Kenya School of Law (KSL), with current CLE points maintained each year.
• Six to nine years of experience in insurance claims processing, with solid knowledge of the insurance sector and how claims operations work.
• Relevant professional certifications such as CPA, AIIK, or ACII are an added advantage.
• Strong understanding of insurance claims management, legal claims and litigation processes, insurance law, and regulatory compliance.
• Ability to interpret policy language and assess coverage, liability, and appropriate reserves for each claim.
• Experience managing external advocates and reviewing legal costs for reasonableness and compliance.
• Competence in claims reporting, data management, and using claims systems to track and analyse information.