March 2016 DirectLine Assurance Claims Analyst Job Opportunity in Kenya

Job Recruitment : Claims Analyst Employment Vacancy

Job Description : Claims Analyst Career Opportunity

DirectLine Assurance

Job Vacancy: Claims Analyst

As a Claims Analyst, you will be working primarily with adjudicated claims data that we receive.
You will be responsible for understanding the incoming claim data, verifications, auditing and preparing audit reports and recommendations.
 
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 guidelines
  • Investigates and maintains basic claims:
  1. Reviews and evaluates coverage and  liability.
  2. Secures and analyses necessary information (i.e., necessary documentations) in the investigation of claims.
  • Monitor internal systems for anomalies and lead the charge on any resulting investigations
  • Ensure 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 and attach to each instruction
  • Conducting audit to internal processes.
  • Negotiation of claims
  • Liaise with the investigation department and follow up on the pending reports
  • Review investigation reports to ensure that all the information requested has been given and reject/reissue the instructions if the same if it is incomplete or does not address the issues raised in the instructions
  • Obtaining adequate evidence through the investigators to ensure that fraudulent claims are dismissed in court. The information should be obtained prior to the claim turning legal Injuries verification and medical re-examinations
  • Liaise with the medical department, ensure prompt booking of claimants for re-exam and follow up on medical reports
  • Obtain interpretation of  complex injuries and drugs administered from the medical department through a nurses summary
  • Ensure that the injuries, treatment and medication given relate to road traffic accidents
  • Following up on reports for specialized doctors when the claimant is referred to them by the medical department
  • Ensuring the medical reports are correct, and that the required verification of injuries has been properly done and documented. Rejecting incomplete medical reports.
  • Ensure 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 documents
  • Ensure that review of claims  and incident files fully comprehensive and completed within the set timelines
  • Ensuring full documentation of claims and incident files by following up the insured, claimant or his advocate  for any outstanding documents
  • Preparation of the liability analysis and obtaining approval on the same within 48 hours of the investigation report being received
  • Issuing instructions to the Company’s advocates when matters turn legal
  • Conducting proper factual and legal research required for achievement of the strategy on the claims
  • Ensure timely preparation of claims files for negotiation or defense
  • Settlement of genuine claims prior to the claimant or third party advocate pursuing compensation through the courts
  • Preparation of monthly claim reports for internal and external use and any other periodical reports as may be directed
Requirements
  • Bachelor’s degree in finance
  • At least 2 years’ experience.
  • Audit experience
  • Negotiation skills
  • Highly analytical, curious and creative
  • Strong organization skills, very detail oriented, with careful attention to work processes
  • Ability to analyze user requests, define requirements, investigate and report conclusions
  • Must have negotiation skills
  • Accuracy and attention to detail
  • Aptitude for numbers and quantitative skills
How to Apply
Individuals who meet the above requirements should send their applications to the email below stating their current and expected salary along with a detailed CV to reach us on or before 30th March 2015. Please indicate the job being applied for in the subject heading of your email.
Short listing is running concurrently as applications are received.
Email: human.resource@directline.co.ke

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