Claims & Client Operations Manager
- Nairobi
- Permanent
- Full-time
The Claims and Client Operations Manager is responsible for overseeing and controlling the end-to-end claims process, including design, data entry, vetting, approvals, and payments, while ensuring exceptional client relationship management within the segment. The role is tasked with designing and implementing innovative initiatives to enhance customer satisfaction and retention, participating in departmental product development efforts, and driving claim cost-control measures. This position plays a key role in ensuring operational efficiency, service excellence, and alignment of claims processes with the company’s strategic objectives.Key responsibilities:
- Responsible for managing BMI claims processes (design, data entry, vetting, approvals & payments).
- Responsible for client relations management by ensuring quality service & periodic interactions.
- Designing & implementing innovative initiatives to improve customer satisfaction & retention.
- Setting up client feedback systems to enable process improvements informed by client inputs/feedback.
- Coordinate processing and payment of claims , management of service providers and operational process improvements.
- Management of claim processing flows to ensure efficiency and manage case management activities.
- Control and oversee provider recruitment into segment provider panel.
- Advice on processes improvement through automation of tasks and processes.
- Coordinating management of relationships with clients, intermediaries and service providers.
- Providing leadership and mentorship to the claims team.
- Developing suitable operational procedures to meet strategic objectives of the organization.
- Review documents and pertinent requirements regarding claims.
- Ensure claims made by the clients are complete in form and complies with the documentary requirements of an insurance claim.
- Respond to both internal and external client inquiries concerning claims process, service providers, and the filing/completion of proper forms.
- Prepare claims registers for claims meetings and update the various claims reports.
- Delegated Authority: As per the approved Delegated Authority Matrix.
- Perform any other duties as may be assigned from time to time.
- Bachelor's’ degree in Nursing.
- Strong AI and Analytical Skills.
- Professional qualification in Insurance is a must.
- At least 6 years' experience in insurance claims management three of which should be in a supervisory position.
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.