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Job Ref. No. HRJIC620
Position: Claims Medical Assessor
We currently have an exciting career opportunity for Claims Medical Assessor, Jubilee Life Insurance Limited. The position holder will report to the Assistant Claims Manager and will be based at Head Office in Nairobi.
The job holder will determine the validity of claims lodged with the company, perform investigations, and prepare summary reports to guide on settlement or decline of claims lodged with the company and Support the claims and medical underwriting functions by reviewing medical reports against policy contract provisions.
- Claim Management–Receive and review all claims with the goal of determining the validity as reported in the claim form. Extrapolate a detailed translation of the medical condition during claims assessment as outlined in the claim documents for the team.Develop and regularly test a matrix of claim causalities to assist the team in fast tracking assessment and decisions. Meet with our medical providers to review in person reports provided on second opinions during claim assessment.Manage the claims payable go out to reasonable minimums to achieve claims budget.
- Wellness and Client servicing–Work in conjunction with the underwriting manager and servicing team to create content for distribution viae–shots/ webinars/ member education day/on–site clinics with the aim of creating value within the product.
- Claim Analysis and Reporting–Provide periodic reports on the nature of claims, causes and trends observed in the area of death and CI & TPD to inform decision making rating.Provide claim analysis report to be inserted into client half year administration reports. Analyse the group life portfolio claims as a measure of risk assessment to contribute towards right pricing
- Compliance–Ensure legal compliance of medical claims data in accordance with the Data protection Act and any other legislative guidelines.
- Team Roles–Work closely with underwriters and servicing team on client relation matters. Work with the servicing team to review policy exclusions in line with medical trends and give clinical talks and presentations to enhance the Life Wellness Campaign. Support the underwriting function by reviewing medical reports against underwriting decisions.
- Develop a nurse on wheel program for targeted clients.
- Any other duties that may be assigned from time to time
- Extensive Medical Knowledge
- Market Awareness
- Customer Focus
- Continuous Innovation
- Ownership & Commitment
- Team Spirit
- Report Writing
- Bachelor of Medicine & Surgery/Diploma in Clinical Science
- IT Proficient (MS Word, Excel, PowerPoint & Outlook)
- ACII/AIIK(Completed or ongoing)
- Minimum of 4years’ relevant experience in a similar position
If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 4th June 2021.
Only shortlisted candidates will be contacted.