Lets Write Africa’s Story Together!
Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.
Job Description
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.
Handles a variety of coverage with a defined loss potential. Reviews and proceses claims of low to moderate face value or liability against policies and coverage information. Decision-making is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subject-matter experts for additional data. Settles and negotiates claims within authorised authority.
Responsibilities
Insurance Claims Administration
Review and analyze assigned insurance claims in line with the organization’s standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.
Insurance Claims Evaluation
Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.
Fraud/Financial Crime Investigation
Carry out assigned information and evidence-gathering activities to support the investigation of cases of suspected fraud or financial crime and the instigation of criminal investigations and/or legal actions.
Fraud/Financial Crime Management
Use established prevention models, systems, and protocols to monitor client or customer activities or transactions, informing more senior colleagues about suspicious activities.
Operations Management
Provide operational support by performing a range of routine activities using existing systems and protocols.
Solutions Analysis
Find the most effective ways to respond to routine functional inquiries. Involves following procedures and precedents.
Document Preparation
Prepare moderately complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for reports.
Resolving Customer Issues
Respond to basic issue escalations promptly and appropriately; provide managerial approvals as required.
Regulatory and Compliance Management
Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.
Operational Compliance
Develop knowledge and understanding of the organization’s policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.
Personal Capability Building
Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.
Skills
Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Insurance Product Management, Insurance Sales, Oral Communications, Presenting Solutions
Competencies
Action Oriented
Collaborates
Drives Results
Ensures Accountability
Financial Acumen
Instills Trust
Manages Complexity
Optimizes Work Processes
Education
NQF Level 3 & NQF Level 2 – Below school leaving
Closing Date
23 January 2025 , 23:59
