Claims Assessor (Analyst) – Leadway Assurance
Job Description
Job Purpose Statement
The role is responsible for assessing and processing all claims to Policy Holders and also ensuring that it is achieved within the recorded time (SLA) in order to retain and attract potential clients to the company. The activities which include but not limited to claims acknowledgement, reviewing claims substantiating documents, producing claims vouchers and follow up till claims settlement offer leave the system under life business.
The role involves
- Acknowledgement of Claims Notification via Life Application/Mail.
- Request for Claims Substantiating Documents.
- Maintains, updates and navigates claim records for prompt claim resolution.
- Claims processing and follow up.
- Claims Reports – Management and Regulatory.
- Providing evidence of payment.
- Validating claim documents.
- Verify identity of claimant and ensure completeness of documents – KYC, Enhanced Due Diligence on claimant.
- Produce voucher for client’s completion.
- Produce Claims Batch for verification and payment.
- The role will support Underwriting, Risk Management & Reinsurance teams and other shared services in the business.
These objectives will be achieved through :
- Obtaining all necessary information on claims for the purpose of settling insurance claims.
- Review claims documents to determine whether claim is within insured’s policy coverage.
- Working with Supervisor in Investigating claim cost, extent of damages and deciding an appropriate amount the company should pay out as claim.
- Uncovering suspicious and fraudulent claims that require further investigation.
- Maintaining a strong understanding of insurance policies and conferring with legal units on claim legal matter where necessary.
- Contributing to the continuous development of the claims process by identifying and implementing several opportunities for the development of products and process improvement.
- Proactively attending and resolving customer’s enquiries, claims compliant using the best method and initiative.
- Communicating feedback on findings to underwriting team on risk improvement.
- Identifying the factors and products that drive the highest frequency and severity of losses.
- Implementation of automated end-to-end workflow processes to reduce manual intervention in internal processing.
- Better knowledge of the Industry, Business and product by staff of Claims function.
- Adherence to TAT on technical service delivery at 98%.
Key Accountabilities (Duties and Responsibilities) Perspective % Weight Output
Financial 43%
· Immediate update of reserve on receipt of additional claim information
· Monitoring of outstanding claims and cleaning up claims’ records on a monthly basis.
· Adherence to Policy Terms & Conditions and proper documentation
· Error free calculation
· Ensure the department is compliant with all statutory provisions
· Identifying & Communicating risk Improvement recommendations arising from claims to Underwriting Department
Internal business processes 29%
· Prompt Claims Registration and Processing
· Prompt review of Claims substantiating documents
· Prompt review of Investigator’s report
· Conveyance of settlement offer upon receipt of final approval within agreed SLA
Customer 14%
· Providing claim status to Clients.
· Detail communication of settlement offer to client
· Prompt resolution of complaints
· Quick response to enquiry
· Adherence to timelines within agreed SLA
Learning and growth 14%
· Register for professional examinations (ACIIN or its equivalent)
· Attend knowledge sharing sessions
· Implementation of knowledge gained and level of initiatives in the department.
Job Dimensions Reporting Relationships: jobs that report to this position directly and indirectly
Direct Reports
· Team Lead, Group Life Claims
· Head, Life Business Claims Assessment
Stakeholder Management: key stakeholders that the position holder will need to liaise/work with to be successful in this role.
Internal
· Leadway Health
· Operations Team
· Actuary
· Customer Service Unit
· Bancassurance Team
· Compliance Team
· Finance Team
· Internal Control
· Internal Audit
External
· Direct Clients
· Medical Consultant
Ideal Job Specifications
Academic:
· Bachelor’s Degree or equivalent from a recognized University (Business Related preferred)
· Master’s Degree is an added advantage.
· Professional Qualification (CIIN)
Functional / Technical skills:
· Dexterity in the use of Microsoft suites
· Good interpersonal skills
· Accuracy and Speed
· Must be receptive to instructions
· Computer friendly
Required Educational Level: Graduate
Experience Level: 1-3 Years
Job Type: Hybrid
Job Role Type: Full-time
Location: Corporate Office
Skills Required: Integrity , Service , Customer Focus , Openness , Respect For Individual , Excellence , Critical Thinking , Teamwork , Strategic Leadership , Achieving Results , Emotional Intelligence , Strategic Business Acumen , Coaching & Mentoring , Diversity And Inclusion , Empathy , Developing People , Esg (environmental, Social & Governance) , Problem-solving , Decision Making , Conflict Management , Change Management , Agility , Strategic Collaboration , Company And Market Knowledge , Planning & Organizing , People/self Management , Negotiation & Persuasion , Customer Centricity , Communication , Financial Acumen , Innovation & Entrepreneurship , Use Of Digital Collaborative Tool , Management Of Information , Insurance Industry Knowledge , Claims Knowledge , Claims Management , Claims Notification & Investigation , Compliance & Operational Risk Knowledge , Computer/statistical Skills , Credit Control & Adjustment Skill , Information/record Administration , Insurance Principles & Practice , Insurance Products And Services , Legal Knowledge , Risk Perception And Assessment , Underwriting And Pricing The Risk , Underwriting Management , Underwriting Process , Customer Service , Reinsurance Management , Claims Recovery , Customer Issue Resolution , Profitability strategies