The Claims Manager – Life role reports to the Chief Executive Director and is responsible for the effective and efficient management of the life insurance claims function. The primary objective is to ensure accurate, timely, and fair assessment and settlement of claims while maintaining prudent and adequate reserving. The role entails ensuring full compliance with regulatory, policy, and governance requirements, driving continuous improvement in claims processes, and providing strong leadership to the claims team.
Primary Responsibilities
Claims Approval & Settlement
- Provide technical oversight and approval of life insurance claims discharge documentation within delegated authority levels.
- Authorize payment of life claims strictly in line with policy provisions, underwriting intent, reinsurance requirements, regulatory rules, and internal governance frameworks.
- Ensure all life claims are assessed, approved, and settled accurately, fairly, and within agreed turnaround times (TATs).
- Exercise sound judgment to ensure settlements reflect policy intent while safeguarding the company against financial, legal, and reputational risk.
- Review and validate complex claims assessments to ensure alignment with medical evidence, legal documentation, underwriting disclosures, and contractual obligations.
- Escalate high‑risk, high‑value, complex, or contentious claims with comprehensive analysis, risk assessment, and clearly articulated recommendations.
Claims Reserving & Review
- Establish, review, and adjust life claim reserves based on evolving claim facts, legal outcomes, and exposure assessments.
- Ensure reserves accurately reflect the ultimate liability and comply with actuarial input, accounting standards, and regulatory requirements.
- Monitor reserve adequacy and trends to minimise reserve volatility and financial misstatement.
- Conduct structured periodic reserve reviews, providing clear justification for material adjustments.
- Collaborate with actuarial and finance teams to enhance reserving accuracy and claims provisioning discipline.
Risk Management & Underwriting Support
- Analyse life claims experience, including mortality, morbidity, loss ratios, and emerging risk trends.
- Identify systemic issues, root causes, anti‑selection risks, and control gaps impacting portfolio performance.
- Provide targeted, data‑driven feedback to underwriting, pricing, and product teams to improve risk selection, pricing adequacy, and policy wording clarity.
- Support continuous enhancement of underwriting guidelines leveraging claims insights and lessons learned.
- Participate in post‑loss reviews, evaluations, investigations, and technical assessments.
Customer Service & Complaints Handling
- Champion fair and transparent claims handling in line with Treating Customers Fairly (TCF) principles.
- Manage escalated, sensitive, or complex claims complaints involving beneficiaries, policyholders, intermediaries, and regulators.
- Ensure professional, timely, and well‑documented communication at all stages of the claims journey.
- Build and maintain strong professional relationships with brokers, agents, and reinsurers.
Regulatory, Governance & Management Reporting
- Prepare, validate, and submit accurate life claims returns and reports to the Insurance Regulatory Authority (IRA) within prescribed timelines.
- Ensure compliance with all statutory, regulatory, reinsurance, and internal reporting standards.
- Maintain high standards of data integrity, documentation quality, and audit readiness.
- Support internal, external, and regulatory audits by providing clear explanations and reconciliations.
- Produce insightful management reports highlighting claims performance, risk exposures, trends, and operational efficiency.
Appeals & Ex‑Gratia Claims Management
- Coordinate preparation and presentation of claim appeals and ex‑gratia requests to management or relevant committees.
- Ensure all ex‑gratia settlements are justified, exceptional, and fully documented.
- Track appeal outcomes to enhance decision‑making consistency.
People Management & Development
- Provide strong leadership, supervision, and mentorship to life claims teams.
- Set performance standards aligned to quality, TAT, and technical excellence.
- Conduct performance reviews and implement development and succession plans.
How to Apply
Interested and qualified candidates should apply online via the CIC Insurance careers portal at careers.cicinsurancegroup.com to submit their applications.
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