Job Description

Duties & Responsibilities:

• Review and adjudicate Retail and Corporate Claims. Make informed decisions in line with authority matrix, policy terms and regulatory guidelines.
• Register and Process claims on company systems.
• Communicate with claimants, beneficiaries, medical professionals, legal representatives, and internal departments to facilitate the claim process.
• Ensure all claims are handled within set timeframes and service level agreements (SLAs).
• Archive documents as per internal and regulatory requirements.
• Attend inquiries channeled through CRM, direct customers and other channels.
• Preserve good working relationship with sales, bancassurance, brokers and Reinsurers.
• Generate claims experience reports.
• Generate policy performance reports.
• Escalate any suspicious/fraudulent cases to the management.
• Ensure compliance with regulatory requirements and regulations.
• Act professionally with due diligence to fully safeguard the interests of the Company in all business activities.

Education:

• Bachelor’s degree in finance or accounting, Healthcare Administration, Business Administration or a related field.

Experience:

• 2 – 5 years’ experience in insurance or health care providers.

Personal Attributes / Skills:

• Analytical skills – mathematical & statistical.
• Attention to detail.
• Proficiency in using Microsoft Office applications and database management.
• Negotiation and interpersonal skills.
• Planning and Organizing skills.
• Report writing skills.

Others:

• Fluency in English language.