Latest Job Vacancies at Britam

Britam jobs, Insurance jobs,

Case Management Officer

Job Purpose:

• Controlling and Managing policies through case management to ensure quality and cost effective care, client service, provider management, processing and payment of EMC claims.

Key responsibilities:

• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration.
• Interact with clients and service providers to ensure that the care is given within policy guidelines.
• Review medical reports and claims for compliance with set guidelines.
• Liaise with underwriters on scope of cover for the various schemes.
• Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
• Discourage poly-pharmacy by diligently challenging of prescriptions and suggesting better alternatives as per
• medical practice.
• Encourage use of generics and cost effective quality drugs where indicated as a method of reducing the
• organizations pharmaceutical expenditure.
• Review documents and pertinent requirements regarding claims from providers and clients.
• Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements
• of an insurance claim.
• Management of relationships with clients, intermediaries and service providers
• Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate risk.
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claims inquiries concerning claims process, service providers, and the
• filing/completion of proper forms.
• Record all claims transactions.
• Prepare claims registers for claims meetings and update the various claims reports.
• Track and follow up on receipt of necessary documents.
• Delegated Authority: As per the approved Delegated Authority Matrix.

 
Knowledge, experience and qualifications required

• Degree in Bachelor of Science in Nursing Sciences from a recognized university.
• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least two-year experience in case management and claims processing.

Technical/ Functional competencies

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.

Leadership category responsibility framework (Core Competencies)
Emerging Leaders in Britam need to:

• Plan, direct and apply efficiencies and resources in order to optimise output and profitability against time, cost and team targets.
• Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation.
• Ensure that department priorities are adhered to and effectively communicated.
• Ensure competent and effective people resources through appropriate coaching, development and people supervision as appropriate.
• Embody a high performance, proactive culture.
• Effectively ensure the adherence to key performance areas, deadlines and goals in order to optimise operational effectiveness.
• Effectively communicate resource needs, possible opportunities and achievements to management in order to aid them in their decision-making.
• Effectively set and monitor priorities and objectives for more junior staff.
• Understand and communicate objectives in relation to the larger organisational impact.
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
• Appropriately model the company values while setting the pace and energy for delivering.
• Effectively manage and communicate change within the department in order to increase staff and process effectiveness.
• Provide access to accurate and consistent information and services across all channels.
• Ensure a seamless experience for clients.
• Improve service delivery for clients.
• Engage in continuous brand building to become the trusted partners to clients.

Unposting Date: 05-07-2023

Corporate Health CSE

Job Purpose:

• Growth of medical insurance business to meet set annual premium targets

Key responsibilities

• Secure new business directly or through intermediaries in all the business channels.
• Maintain excellent customer service to intermediaries and clients.
• Service existing business.
• Follow up on renewals for medical insurance business.
• Forward proposal forms and all KYC documents to underwriting department.
• Ensure timely collections of premium as per the credit control policy.
• Prepare weekly reports as required by the BDM Corporate health.
• Undertake initial underwriting in accordance with set guidelines to ensure sound acceptance of risk.
• Respond to customer and client enquiries.
• Delegated Authority: As per the approved Delegated Authority Matrix.
• Perform any other duties as may be assigned from time to time. 

Knowledge, experience, and qualifications required

• Bachelors’ degree in a business-related field.
• Professional qualification in Insurance (ACII, IIK).
• 2-4 years’ relevant experience in the insurance industry.

Leadership category responsibility framework (Core Competencies)
Emerging Leaders in Britam need to:

• Plan, direct and apply efficiencies and resources to optimise output and profitability against time, cost, and team targets.
• Effectively communicate strategic and operational departmental goals and objectives to peers and others to ensure proper implementation.
• Ensure that department priorities are adhered to and effectively communicated.
• Ensure competent and effective people resources through appropriate coaching, development, and people supervision as appropriate.
• Embody a high performance, proactive culture.
• Effectively ensure the adherence to key performance areas, deadlines, and goals to optimize operational effectiveness.
• Effectively communicate resource needs, possible opportunities, and achievements to management to aid them in their decision-making.
• Effectively set and monitor priorities and objectives for more junior staff.
• Understand and communicate objectives in relation to the larger organizational impact.
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
• Appropriately model the company values while setting the pace and energy for delivering.
• Effectively manage and communicate change within the department to increase staff and process effectiveness.
• Provide access to accurate and consistent information and services across all channels.
• Ensure a seamless experience for clients.
• Improve service delivery for clients.
• Engage in continuous brand building to become the trusted partners to clients.

Unposting Date: 27-06-2023

Counter Fraud Officer – (2300004O)

Job Purpose:

• The Counter Fraud Officer is responsible for all facets of fraud prevention, detection, investigation and remediation within the Britam.
• The jobholder is responsible for investigations into allegations of fraud, in accordance with key investigative methodologies, legislation and company policies while delivering proactive counter fraud reviews in relation to the adequacy and effectiveness of internal controls and their ability to prevent, detect and deter fraud. Investigations and reviews assigned will be in complex and/or medium risk areas.

Key responsibilities:

• Undertaking fraud investigations of cases reported to the Group Forensics Services from various sources including whistleblowing hotline, customer escalations, letters to management, Internal Audits, direct tip offs, inter alia.
• Evaluate potential fraud indicators and the impact of current fraud trends and make recommendations as to appropriate mitigation.
• Preparing and undertaking field assignments to obtain relevant evidence and information.
• Applying theories, concepts and approaches relevant to administrative investigations.
• Applying various research methodologies and sources as required in investigations, including using electronic sources on the Internet, intranet and other databases. 
• Conduct objective, fair, thorough, unbiased and timely investigations into allegations of fraud, waste or abuse committed against the organization.
• Preparing forensic reports based on evidence gathered from the various sources of information.
• Participate in formulating and implementing a comprehensive Fraud Risk Management framework within the Retail Segment.  
• Reporting fraud cases to IRA or Police to facilitate prosecution of agents, staff or other Britam stakeholders involved in fraudulent business practices and adducing evidence in a court of law.
• Maintaining a database of cases received and periodically assist in preparation of Management, Board and other relevant reports and statistics as required.
• Propose, discuss and agree recommendations to improve control weaknesses identified during investigations and regularly follow up for their implementation.
• Managing and strengthening bonds with law enforcement agencies and other Industry & non-industry players to enhance co-operation on mutually beneficial information, fraud investigations, asset tracing & recovery etc.
• Conducting anti-fraud awareness training to various stakeholders.

Key Performance Measures:
As described in your Personal Score Card.

Knowledge, experience and qualifications required

• A degree from a recognized university.
• 2-4 years’ experience in criminal or administrative investigations; preferably in the insurance industry.
• Strong investigative, analytical, and report-writing skills.
• Attention to detail with the ability to sift out relevant information from different sources.
• Certified Fraud Examiner is an added advantage.
• Knowledge of business operations, fraud investigations, and prosecution process including preparation of evidence.
• Knowledge of theories, concepts and approaches relevant to criminal and administrative investigations.
• Knowledge of various research methodologies and sources, including electronic sources on the Internet, intranet and other databases.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.

Leadership category responsibility framework (Core Competencies):
Emerging Leaders in Britam need to:

• Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost and team targets.
• Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation.
• Ensure that department priorities are adhered to and effectively communicated.
• Ensure competent and effective people resources through appropriate coaching, development and people supervision as appropriate.
• Embody a high performance, proactive culture.
• Effectively ensure the adherence to key performance areas, deadlines and goals in order to optimize operational effectiveness.
• Effectively communicate resource needs, possible opportunities and achievements to management in order to aid them in their decision-making.
• Effectively set and monitor priorities and objectives for more junior staff.
• Understand and communicate objectives in relation to the larger organizational impact.
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
• Appropriately model the company values while setting the pace and energy for delivering.
• Effectively manage and communicate change within the department in order to increase staff and process effectiveness.
• Provide access to accurate and consistent information and services across all channels.
• Ensure a seamless experience for clients.
• Improve service delivery for clients.
• Engage in continuous brand building to become the trusted partners to clients.

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