Third Party Insurance Claims Officer Job in Kenya

Job Title: Claims Officer – Third Party Insurance
Company Profile: Our client is a leading provider of innovative, reliable and affordable motor insurance services backed by unmatched service for over 10 years in the transport industry.They seek to improve their services by employing professionals who are experts in the above vacancy.

Key Responsibilities
 Thorough and  detailed analysis of claim documents to enable early fraud  detection and to effectively address the fraudulent claims within the company's policies and  guidelinesEnsure that verification and investigation instructions are issued within 48 hours days of receipt of claim documents or new incident files. Clear claim documents under investigation must be attached to each instructionLiaise with the investigation department and  follow  up on the pending reportsChecking the investigation reports to ensure that  all the information you requested or that  is required has been given and rejecting/reissuing the instruction the same if it is incomplete or does not address the issues raised in the instructionsObtaining adequate evidence through the investigators to ensure that fraudulent claims are dismissed in court. The information should be obtained prior to the claim turning legalInjuries verification and medical re-examinationsLiaise with the medical department, ensure prompt booking of claimants for re-exam  and  follow  up on medical reportsObtain interpretation of  complex injuries and  drugs administered from the medical department through a nurses summaryEnsure that  the injuries, treatment and  medication given  relate  to road  traffic accidentsFollowing up on reports for specialized doctors when  the claimant is referred  to them  by the medical departmentEnsuring the medical reports are correct, and that the required verification of injuries has been properly done and documented. Rejecting incomplete medical reports.Claims and Incidents ManagementEnsure that data is accurately and efficiently updated in the claims system resulting in the system data being a reflection of the physical file through proper update of the system data of the claims and incidents. The data should be updated within 24 hours of receiving claim or incident documentsFollowing up on collection of policy excess from the insured and  intermediariesEnsure that  review of claims  and  incident files fully comprehensive and  completed within the set timelinesMaintain a proper and  accurate reserves on claims and  incidents, and  ensure the relevant JournalVouchers are presented for Approval within 24 hours of receipt of any additional informationEnsuring full documentation of claims and  incident files by following up the insured, claimant or his advocate for any outstanding documentsPreparation of the liability analysis and  obtaining approval on the same within 48 hours of the investigation report  being receivedIssuing instructions to the Company's advocates when  matters turn legalDeal with  correspondence from the claimants and  their advocates and  responding to the same within 72 hours from the date of receipt of such correspondencePursuing any due recoveries from the insured and  third parties, and  ensuring that  insured or his employee supplies all the requisite documents required to successfully pursue the recoveryConducting proper factual and  legal  research required for achievement of the strategy on the claimsEngaging  with third party  service providers  where  necessary to build evidence on liability, medical injury disputes  etcEnsure timely preparation of claims files for negotiation or defenseSettlement of genuine claims prior to the claimant or third party  advocate pursuing compensation through the courtsSettlement of genuine claims  with third party  advocates and  claimants within 30 days from the date of approval of the settlement proposalPreparation of monthly claim reports for internal  and  external  use and  any other periodical reports as may be directedAddress enquiries in the interpretation of the PolicyMonitoring changes in relevant legislation and the regulatory environment, and advising the company on the impact of such changes.Attending court to represent the Company as a witness or any other capacity as may be approved by the CompanyMaintain highest level confidentiality concerning the sensitive, strategic and  integral legal  and  other information, data, decisions and  developments taking  place at the companyParticipate and  offer valuable advice to the Company and  Departmental Committees which you are nominated or elected toAny other duties that  maybe assigned from time to timeBachelors of Laws Degree, Diploma in Law(KSL),Admission as an Advocate with a current practicing Certificate,1 Years Post Admission experience in LitigationExperience or knowledge in handling running down mattersIf interested send in your CV and application letter to recruitkenya@kimberly-ryan.net, indicating the job position on the job title