Claims Officer Job in Nairobi, Kenya
Category: General Jobs in Kenya
Posted: Oct 28, 2013
Claims Officer Job in Nairobi, Kenya
Position Title: Claims Officer
Office Location: Nairobi,Kenya
Our client is a leading provider of innovative, reliable and affordable motor insurance services backed by unmatched service for over 10 years in the transport industry.
They seek to improve their services by employing professionals who are experts in the above vacancy.
- Thorough and detailed analysis of claim documents to enable early fraud detection and to effectively address the fraudulent claims within the company’s policies and guidelines
- Ensure that verification and investigation instructions are issued within 48 hours days of receipt of claim documents or new incident files. Clear claim documents under investigation must be attached to each instruction
- Liaise with the investigation department and follow up on the pending reports
- Checking the investigation reports to ensure that all the information you requested or that is required has been given and rejecting/reissuing the instruction the same if it is incomplete or does not address the issues raised in the instructions
- Obtaining adequate evidence through the investigators to ensure that fraudulent claims are dismissed in court. The information should be obtained prior to the claim turning legal
2. Injuries verification and medical re-examinations
- Liaise with the medical department, ensure prompt booking of claimants for re-exam and follow up on medical reports
- Obtain interpretation of complex injuries and drugs administered from the medical department through a nurses summary
- Ensure that the injuries, treatment and medication given relate to road traffic accidents
- Following up on reports for specialized doctors when the claimant is referred to them by the medical department
- Ensuring the medical reports are correct, and that the required verification of injuries has been properly done and documented. Rejecting incomplete medical reports.
3. Claims and Incidents Management
- Ensure that data is accurately and efficiently updated in the claims system resulting in the system data being a reflection of the physical file through proper update of the system data of the claims and incidents. The data should be updated within 24 hours of receiving claim or incident documents
- Following up on collection of policy excess from the insured and intermediaries
- Ensure that review of claims and incident files fully comprehensive and completed within the set timelines
- Maintain a proper and accurate reserves on claims and incidents, and ensure the relevant Journal Vouchers are presented for Approval within 24 hours of receipt of any additional information
- Ensuring full documentation of claims and incident files by following up the insured, claimant or his advocate for any outstanding documents
- Preparation of the liability analysis and obtaining approval on the same within 48 hours of the investigation report being received
- Issuing instructions to the Company’s advocates when matters turn legal.
- Deal with correspondence from the claimants and their advocates and responding to the same within 72 hours from the date of receipt of such correspondence
- Pursuing any due recoveries from the insured and third parties, and ensuring that insured or his employee supplies all the requisite documents required to successfully pursue the recovery
- Conducting proper factual and legal research required for achievement of the strategy on the claims
- Engaging with third party service providers where necessary to build evidence on liability, medical injury disputes etc
- Ensure timely preparation of claims files for negotiation or defense
- Settlement of genuine claims prior to the claimant or third party advocate pursuing compensation through the courts
- Settlement of genuine claims with third party advocates and claimants within 30 days from the date of approval of the settlement proposal
- Preparation of monthly claim reports for internal and external use and any other periodical reports as may be directed
4. General Duties
- Address enquiries in the interpretation of the Policy
- Monitoring changes in relevant legislation and the regulatory environment, and advising the company on the impact of such changes.
- Attending court to represent the Company as a witness or any other capacity as may be approved by the Company
- Maintain highest level confidentiality concerning the sensitive ,strategic and integral legal and other information, data, decisions and developments taking place at the company
- Participate and offer valuable advice to the Company and Departmental Committees which you are nominated or elected to
- Any other duties that maybe assigned from time to time
Experience and Qualifications
- Bachelors of Laws Degree, Diploma in Law (KSL),
- Admission as an Advocate (or Awaiting Admission) with a current practicing certificate
- 2 Years experience in Legal work, 1 of which must be in a Law firm of good standing or an Insurance Company.
If interested, kindly send in your CV and Application Letter to [email protected] and indicate the job position on the subject title