Retail Claims Officer

Job title : Retail Claims Officer

Role Summary

• The Retail Claims Officer is responsible for the efficient processing and administration of individual life insurance claims, ensuring that claims are accurately assessed, properly documented, and processed within established timelines.
• The role involves reviewing claim submissions, validating supporting documentation and policy coverage, liaising with relevant stakeholders to resolve claims-related issues, and maintaining accurate claims records while ensuring compliance with internal policies and applicable regulatory requirements.

Principal Responsibilities

• Process and administer Individual Life insurance claims, including terminations, partial withdrawals, maturities, and death claims.
• Review claims documentation and ensure all required information is complete before processing and payment.
• Prepare claim payment memoranda for management and Board approval in line with approved authority limits.
• Investigate claims and verify policy coverage to determine claim validity and entitlement before settlement.
• Prepare and maintain weekly, monthly, and quarterly claims reports for management review and decision-making.
• Maintain accurate and complete claims records, including claim files, supporting documents, and communication logs.
• Provide excellent customer service by responding promptly to claim enquiries and guiding customers through the claims process.
• Work closely with internal and external stakeholders to resolve claims-related issues and ensure timely settlement of claims.
• Support internal control, audit, and compliance activities by providing required information and addressing audit queries.
• Support business retention and growth initiatives by remarketing customers after policy maturity or termination, identifying new business opportunities, and participating in Agency and Bancassurance sales meetings.

Qualifications

• Bachelor's Degree or HND in Insurance, Actuarial Science, Business Administration, Economics, Accounting, Finance, or related discipline.
• Professional insurance certification (ACIIN, ACII, or equivalent) will be an added advantage.

Required Experience & Knowledge

• 3 - 5 years' experience in insurance claims administration, customer service, or insurance operations.
• Practical experience in processing and assessing life insurance claims would be an advantage.
• Good understanding of life insurance products, policy terms, conditions, exclusions, and claims procedures.

Key Competencies

• Knowledge of Claims Management Policies and Procedures
• Data Collection and Entry, with Proficiency in Microsoft Excel
• Customer Negotiation and Problem-Solving Skills
• Report Analysis and Presentation Skills
• Relationship Management
• Attention to Detail
• Time Management and Prioritization
• Knowledge of Regulatory and Compliance Requirements