Jobs at Britam

Job Purpose:

The role of the DDO Associate will be to:

1. Provide prompt, efficient and effective operational support by entering into LOB systems requisite customer and related product information as per given documentation, performing verification and quality assurance of customer data & information on the customer record and CRM data
2. Manage and maintain all company’s physical documents and records
3. Co-ordinate activities and support services within the Registry function
4. Give effective supervision to the outsourced registry assistants
5. Scanning, assembling and franking of policy documents and dispatch process

Key Responsibilities

1. Ensure client details/ instructions are accurately and timely processed in line with the requisite processes 
2. Process all reimbursements as per SLA
3. Process all endorsements  as per SLA
4. Process all policies new and renewal as per SLA
5. Process all claims from service providers as per SLA
6. Process all reconciliation service provider invoices are reviewed and shared as per SLA 
7. Co-ordinate any out-sourced services of document storage and retrieval
8. Accurate and timely processing of client requests
9. Manage escalation reports of recurrent issues vis-à-vis agreed Service Level Agreements.
10. Escalate quality issues to Operations manager for management.
11. Implement the customer experience strategy in the respective business divisions
12. Investigate and respond to all internal and external customer enquiries promptly.
13. Process all approved underwriting policies and claims processing within the provided SLA’s 
14. Escalate complex queries to the appropriate functional area
15. Maintain regular internal (to staff) and external (to customers) communication on Customer Service matters.
16. Investigate and respond to all customer enquiries promptly.
17. Carry out customer and product related document processing
18. Respond to customer queries in a professional manner
19. Make customers’ experiences better by ensuring customer satisfaction
20. Ensure high standards of Customer Service are maintained in all at level

Knowledge, experience and qualifications required

1. Bachelor’s degree in a business related field
2. At least 2- 4 years’ experience in a similar position
3. Computer Literate; emphasis on Microsoft Office and EDMS

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Job Purpose:                                

Ensuring that claims are accurately assessed, processed, and paid in accordance with company regulations and standards, through the provision of guidelines and direction to the staff in the claims section

Key responsibilities

1. Ensure prompt registration and acknowledgment of new claims upon receipt of notification.
2. Evaluate and settle claims, to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
3. Confer with legal counsel on claims requiring litigation and defense in courts
4. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
5. Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis such as ex-gratia & declines
6. Processing of claims within the set service levels agreements for excellent customer service
7. Preparation of weekly & monthly claims reports to the team leader upon request.
8. Portfolio analysis and risk recommendation to the underwriting department upon analysis of trends in motor claims.
9. Recommendation for approval of payment and discharge vouchers within limits.
10. Oversee the preparation of claims statistical reports within the stipulated time.
11. Delegated Authority:  As per the approved Delegated Authority Matrix
12. Initiate and pursue recovery of claims from insurers of negligent partners by ensuring demand letters are send out, filed and TP register is updated
13. Retrieve, document, and pursue facultative claims 
14. Prompt settlement of garage invoices to save on early payment discount
15. Negotiate fees with other service providers to save on costs
16. Maintain adequate initial reserves as per reserve guidelines and participate in the monthly, quarterly and annual reserves reviews
17. Shoulder TLs & other managers in client’s meetings
18. Ensure prompt disposal of motor salvages to stop storage charges accruing – Rotational basis
19. Perform any other duties as may be assigned from time to time

Key Performance Measures

1. As described in your Personal Scorecard

Knowledge, experience and qualifications required

1. Bachelors of degree Actuarial or Applied Statistics
2. Progress in professional qualification in Insurance (ACII, FLMI or AIIK)
3. 2-3 years’ experience in insurance claims processing
4. Data analytics experience added advantage
5. Knowledge and experience in the insurance sector

Technical/ Functional competencies

1. Knowledge of insurance regulatory requirements
2. Knowledge of insurance products
3. Sales and marketing management skills
4. Good data analytical skills

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Job Purpose

Reporting to the Team Leader Corporate Care Management, The role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

Key responsibilities

1. Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
2. Interact with clients and service providers to ensure that the care is given within policy guidelines
3. Review medical reports and claims for compliance with set guidelines
4. Liaise with underwriters on scope of cover for the various schemes
5. Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
6. Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
7. Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
8. Delegated Authority:  As per the approved Delegated Authority Matrix
9. Prepare periodic reports for management on medical claims
10. Ensure claims are processed within the stipulated time 
11. Perform any other duties as may be assigned from time to time

Key Performance Measures

1. As described in your Personal Score Card

Knowledge, experience and qualifications required

1. Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
2. Moderate understanding of insurance concepts
3. Professional qualification in FLMI, ACII and IIK.
4. 5-8 years’ experience in case management two of which should be in a supervisory position