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.