Jubilee Insurance – Claims Medical Assessor.

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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.

Role Purpose

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.

Main Responsibilities

  1. Claim ManagementReceive 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.
  2. Wellness and Client servicingWork in conjunction with the underwriting manager and servicing team to create content for distribution viaeshots/ webinars/ member education day/onsite clinics with the aim of creating value within the product.
  3. Claim Analysis and ReportingProvide 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
  4. ComplianceEnsure legal compliance of medical claims data in accordance with the Data protection Act and any other legislative guidelines.
  5. Team RolesWork 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.
  6. Develop a nurse on wheel program for targeted clients.
  7. Any other duties that may be assigned from time to time

Key Competencies

  1. Extensive Medical Knowledge
  2. Market Awareness
  3. Customer Focus
  4. Continuous Innovation
  5. Ownership & Commitment
  6. Team Spirit
  7. Report Writing

Qualifications

  1. Bachelor of Medicine & Surgery/Diploma in Clinical Science
  2. IT Proficient (MS Word, Excel, PowerPoint & Outlook)
  3. ACII/AIIK(Completed or ongoing)

Relevant Experience

  1. 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.

https://jubileeinsurance.com/ke/careers/

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Jubilee Insurance

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