Job Description
Key Responsibilities:
1 a). Claims loss ratio management and cost efficiency - 30%
Review of Claims
- Ensure & monitor compliance by claims team to initial and subsequent reserving for all reported claims
- Ensure all auctioneers' fees are drawn to scale as outlined in the Auctioneers Act and Rules
- Approve claim payments in a timely manner after confirmation of admissibility.
- Collaborate with the Finance Department to manage claims costs
- Ensure claims which are above our retention are reported accurately and in a timely to reinsurance Section as required by procedure.
- Ensure accuracy of data and information shared with IRA on legal complaints/queries
- Monitor and ensure accuracy and constant update of data for Summons, judgments, and appeal registers in the system & shared folder.
- Ensure all third parties injury claims are properly investigated.
Service provider management and negotiations
- Negotiate and ensure we settle advocates/auctioneers fees as per the appropriate statutes
- Ensure service provider fees are settled as per signed SLA’s and agreed timelines.
Judgments/Appeals/Auctioneer costs
- Manage judgments by enforcing out of court settlements and scheduling the payments
- Follow up on appeals and advise on status of the same on a monthly basis.
- Managing and ensuring auctioneer’s fees are settled to scale.
Recovery of appeal deposits
- Monitor and update the progress of appeal deposits currently in joint earning accounts. Recovery of these deposits is informed by the progress and success of the appeal.
b.) Financial planning and liquidity management
Recoveries
- Ensure and spearhead the legal team in pursuing recoveries totaling Kshs 20 million per year. Subject for review.
- Ensure that all recoveries that are almost time-barred have been filed with advocates before they lapse.
Service level agreements
- Restore and retain positive relationships with service providers (advocates, auctioneers)
- Ensure that service providers' invoices are paid on time as per service level agreements
- Collate and promptly distribute service provider invoices and follow up on the payments to conclusion.
2. Customer feedback - 30%
Customer service, communication, and feedback - 15%
- Responding to emails – within 24 hours from receipt of the email
- Distribution of legal correspondence.
- Follow up on matters that have been delayed.
Service Charter - 15%
- Ensure the legal sections comply with customer service standards & service charter.
- Issuing instructions to act to advocates within 5 working days.
- Build and maintain relationships with a range of stakeholders, including the ability to understand different stakeholders’ motivations and the ability to influence and persuade ensure.
- Ensure all walk-in customers are attended to and issues resolved.
3. Internal Controls & processes - 20 %
Internal Controls and Reporting
Enforcement of internal controls and reporting - 10%
- Institute systems to monitor, control, and manage legal claims
- Enforce and monitor legal authorization matrices
- Investigate, evaluate, and settle legal matters, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a sustainable loss ratio
- In conjunction with Claims Manager, establish specific goals for handling legal claims, develop and implement a tactical plan to support goal attainment relative to productivity, loss ratio, loss adjustment expenses and other agreed upon metrics
- Control and direct activities of defense counsel, directly or indirectly through staff
- Ensure all applicable claims are reported accurately and promptly to reinsurance as required by procedure
- Ensure compliance with statutory regulatory bodies and serve as lead contact on matters pertaining to legal
- Prepare monthly management reporting on summons/litigation/case management with the respective advocates on record/ judgments/appeals in timely, accurate, informative reports to management for decision making
- Attend all scheduled meetings with clients to facilitate smooth operations
- Enforce compliance to the set internal audit controls and other periodic recommended internal processes by management
- Co-ordinate with the relevant departments especially claims (non-legal) and customer experience to ensure the claims process is as painless as possible.
- Adhere to local regulatory and governance requirements throughout the life of the claim to ensure that decisions are made using the right standards.
Legal Process Management - 5%
- Verify and analyse data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
- Ensure in-depth investigation of claims through direct or indirect contact with policyholders, claimants, physicians, contractors and advocates ensuring that any detected fraud case is handled as per company policy guidelines.
- Proactively respond to company and industry trends
- Develop tools and recommendations for claims risk management/fraud detection.
- Identify, appoint, and maintain an effective panel of claim service providers
- Maintain and Review claims SOPs( Standard Operating Procedures)
- Review, implement, and revise the salvage process to adhere to laid down guidelines on salvage management
- Review, monitor, and ensure constant update of the judgment register and evaluate the risk/liability that the company is carrying
- Ensure that both claims and legal departments fully adhere to laid down TATs
- Implement an escalation matrix for pending urgent matters
- Develop and implement a repudiation matrix
4: QUALITATIVE PERFORMANCE & COMPETENCIES - 20 %
Talent Management - 5%
- Administrative management & supervision of all claims staff.
- Performance Management, staff development, and motivation.
- Leading and motivating the claims team to ensure the achievement of claims department objectives in alignment with the company strategy
- Ensure staff are well supervised, trained and developed to be technically competent to perform their duties
- Ensure that the Performance Management the process is embraced and continuously carried out for effective and efficient service to our customers with a view to achieve overall company business goals
Learning and Growth - 5%
- Recruit and motivate employees in line with the organization's strategic plans and ensure compliance with company HR policies/ procedures
- Facilitate and support talent management, performance management, and development
- Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications.
- Review, monitor, and provide technical expertise to staff and ensure that there is systematic and adequate on-the-job training.
Living KOIL Values - 10%
- Integrity
- Excellence
- Customer Driven
- Innovation
- Team Work