Head of Claims - Kenya at KPMG

Key roles and responsibilities

Policy development and implementation

• Develop and implement claims policies, procedures, and standards in line with the company's vision, mission, and values.
• Ensure adherence to the company's enterprise policies, and relevant regulations and legislations in Kenya.

Operations management

• Responsible for claim operations, budget, performance, and customer experience.
• Ensure the timely and accurate processing and payment of claims, delivering a good customer experience while ensuring regulatory compliance.
• Work closely with Head of Group Claims Management to ensure the claims process activities outsourced to service entities or third-party suppliers, are delivered effectively and in accordance with service agreements.

Performance monitoring and reporting

• Monitor and analyze claims data and trends, providing regular management information (MI) and operational performance reports to management committees and the Board.
• Review and update the claims service level agreements and key performance indicators to ensure target achievement and customer satisfaction.
• Oversee the risk and controls in the claims operation, ensuring compliance with enterprise policies, procedures and regulatory requirements.
• Manage service quality through robust quality assurance to ensure adherence to the quality and compliance standards.

Risk management and compliance

• Provide the Board with sound advice, assurance and useful and timely reports from the Audit committee.
• Manage relationships with external stakeholders including Head of Internal Audit and external regulatory bodies, external Audit Partner and auditors.
• Identify, assess, monitor, and manage operational risks associated with the claims handling process with support from the risk management function.
• Collaborate with the claims fraud, waste, and abuse (FWA) function on prevention and detection measures and in driving adherence to anti-fraud policies and regulations.
• Ensure adequate operational resilience and business continuity planning within the claims process to minimize customer impact during disruptions.

Continuous improvement and innovation

• Collaborate with the centralized Claims Process and Payment Integrity function to recommend improvements to local claims policies, procedures, and standards in line with the company's vision, mission, and values.
• Handle complex and escalated claims cases and complaints, ensuring fair and satisfactory resolution.
• Identify and implement best practices and innovations in the claims handling process, enhancing the efficiency and effectiveness of claims systems and processes.
• Drive continuous improvement initiatives within the department to deliver change through innovative solutions, including automation, data analytics, and AI.

Academic/Professional qualifications and Experience:

• A bachelor's degree in Business Administration, Finance, Management, or a related field from an accredited reputable institution.
• A minimum of 5 years of experience in claims management in international private medical insurance (IPMI), or other financial services industries such as domestic private medical insurance or life insurance.
• Experienced claims management and customer service professional.
• Strong ability and proven track record in driving significant claims savings and operational expense cost reductions.
• Proven ability to deliver strong KPI performance in a claim management function through excellent leadership and a strong focus on results.
• Strong problem-solving and decision-making skills with a strong leaning towards innovation and improvement.
• Excellent communication, teamwork and collaboration skills, with the ability to work effectively and cooperatively with others.