Head of Claims – Kenya Job KPMG
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Head of Claims – Kenya Job 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.
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How To Apply
If you are interested in this exciting opportunity, Please send your application for your consideration to this email: hrservices@kpmg.co.ke quoting ‘Head of Underwriting and Enrolment’ by 4 October 2024.
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