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This position is responsible for managing claims within the set guidelines with an aim of mitigating losses and improving profitability. This involves timely and efficient settlement of valid claims, resolution of contentious claims and managing stakeholder relationships.
HEALTH CLAIMS MANAGER
- Company:APA Insurance
- Location: Nairobi
- Employment Type:Permanent
- Job Id:dFqRHMqJ8Y
KEY PRIMARY RESPONSIBILITIES
- Reviewing of outstanding claims regularly and monitoring team adherence to claims payment TATs;
- Reviewing and revising processes in the claims departments for adherence to the customer charter and policies;
- Reviewing and approving claim payments and commenting on claims that are to be declined;
- Managing stakeholder relationships as detailed in the manuals;
- Managing claim costs through strategic initiatives of the company to ensure profitability of the business;
- Tracking claims activity through reports to arrest any adverse trends;
- Implement identified projects targeted at achieving transformation in claims management processes, technology, partnerships.
- Complying with statutory, regulatory and internal control processes at the business units including internal and external audit recommendations;
- Developing departmental budget and business plans to achieve the set company targets;
- Entrenching performance based appraisal of departmental staff in line with their set KPIs and departmental targets;
- Participating in company CSR and brand building activities in liaison with other departments;
- Training, coaching and mentoring staff in order to improve performance and cohesion within the department;
- Implementing interdepartmental SLA in liaison with other departmental heads;
- Participating in management meetings, projects and committees as assigned.
- Bachelor’s degree in Commerce/Science/Nursing/Health or an equivalent.
JOB SKILLS AND REQUIREMENTS
- Interpersonal and Communication skills
- Excellent market and industry knowledge
- Educational background in business/ claims with leadership experience and training from recognized institutions
- Relevant professional qualification
- At least 8 years relevant experience with at least 3 year managerial experience
- Demonstrated experience engaging service providers at a high level, and experience negotiating claims handling terms with providers
- Demonstrated strong experience in driving technology adoption in health insurance
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