What Jobs are available for Claims Specialist in Kenya?
Showing 2322 Claims Specialist jobs in Kenya
Medical Malpractice Claims Specialist
Posted 1 day ago
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Job Description
Our client is seeking a dedicated and detail-oriented Medical Malpractice Claims Specialist to join their fully remote claims department. This critical role involves managing and resolving complex medical malpractice claims, requiring a unique blend of investigative acumen, analytical prowess, and empathetic communication. The successful candidate will be responsible for overseeing claims from initial notification through final resolution, ensuring adherence to policy terms, legal requirements, and our client's high standards of service. You will conduct in-depth investigations, meticulously reviewing medical records, expert reports, and legal documentation to assess liability and damages. A comprehensive understanding of medical terminology, healthcare practices, and relevant legal frameworks is essential. This position is 100% remote, offering the flexibility to work from any location, provided you have a stable internet connection and a suitable home office environment. You will collaborate closely with internal legal teams, external defense counsel, medical experts, and policyholders, acting as a central point of contact and facilitator. Responsibilities include evaluating coverage, reserving appropriately, and negotiating settlements when warranted, always with a focus on achieving the best possible outcome for all parties. Maintaining clear, accurate, and up-to-date claim files and preparing comprehensive reports for senior management are key duties. The ability to work autonomously, manage multiple complex cases simultaneously, and navigate sensitive situations with discretion and professionalism is highly valued. This remote role demands a proactive approach, excellent time management skills, and a commitment to continuous learning in the evolving field of medical malpractice. If you are an experienced claims professional with a passion for healthcare and a desire to contribute to a leading insurance provider in a remote capacity, we invite you to apply.
Responsibilities:
Responsibilities:
- Manage and investigate medical malpractice claims from assignment to closure.
- Conduct thorough reviews of medical records, diagnostic reports, and other relevant documentation.
- Assess liability, damages, and coverage based on policy terms and applicable laws.
- Liaise with healthcare providers, legal counsel, policyholders, and other stakeholders.
- Obtain and evaluate expert opinions to support claim resolution.
- Negotiate settlements and manage litigation proceedings in coordination with legal counsel.
- Maintain accurate and complete claim files, documenting all investigative steps and decisions.
- Prepare detailed reports on claim status, reserve adequacy, and potential exposures.
- Ensure compliance with all regulatory requirements and company policies.
- Provide clear and empathetic communication to all involved parties.
- Bachelor's degree in Healthcare Administration, Law, Nursing, or a related field.
- Minimum of 5 years of experience in handling medical malpractice claims.
- In-depth knowledge of medical terminology, healthcare systems, and legal principles related to malpractice.
- Strong analytical, critical thinking, and problem-solving skills.
- Excellent written and verbal communication skills, with the ability to negotiate effectively.
- Proficiency in claims management software and standard office applications.
- Demonstrated ability to work independently and manage a high volume of complex cases remotely.
- High level of integrity, discretion, and professionalism.
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Senior Insurance Claims Analyst
Posted 1 day ago
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Job Description
Our client, a leading insurance provider, is seeking a highly analytical and detail-oriented Senior Insurance Claims Analyst to join their fully remote claims processing team. This role offers the unique advantage of working from home while playing a critical role in ensuring fair and efficient settlement of insurance claims. You will be responsible for investigating complex claims, assessing coverage, determining liability, and negotiating settlements within policy limits. The ideal candidate will possess a deep understanding of insurance policies, claims procedures, and relevant legal frameworks. You will leverage your analytical skills to scrutinize claim details, identify potential fraud, and recommend appropriate actions. This position requires excellent communication skills, as you will interact with policyholders, legal representatives, and other stakeholders. You will also contribute to the development and refinement of claims handling best practices and provide guidance to junior claims adjusters. This is an exceptional opportunity to advance your career in the insurance sector, working remotely to manage a diverse portfolio of claims. The focus of the claims processed might relate to policies that serve the **Thika, Kiambu, KE** region, but the role itself is entirely remote. Your ability to work independently, manage your workload effectively, and maintain a high level of accuracy will be essential. Key Responsibilities:
- Investigate, evaluate, and process complex insurance claims accurately and efficiently.
- Interpret insurance policies to determine coverage and liability.
- Negotiate settlements with policyholders and third-party claimants.
- Identify and investigate potential fraudulent claims.
- Maintain detailed and accurate claim files and documentation.
- Communicate effectively with policyholders, agents, legal counsel, and other parties.
- Ensure compliance with all applicable laws, regulations, and company policies.
- Provide guidance and mentorship to junior claims adjusters.
- Contribute to the continuous improvement of claims handling processes.
- Analyze claims data to identify trends and recommend proactive risk management strategies.
- Bachelor's degree in Business Administration, Finance, Law, or a related field.
- Professional insurance certifications (e.g., ACII, CPCU) are highly desirable.
- Minimum of 5 years of experience in insurance claims handling, with a focus on complex claims.
- Strong understanding of insurance contracts, legal principles, and claims investigation techniques.
- Excellent analytical, problem-solving, and decision-making skills.
- Proficiency in claims management software and Microsoft Office Suite.
- Exceptional written and verbal communication skills.
- Proven ability to manage a remote caseload and work independently.
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1
Lead Insurance Claims Analyst - Remote
Posted 1 day ago
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Job Description
Our client, a rapidly expanding insurance provider, is actively seeking a seasoned Lead Insurance Claims Analyst to join our dynamic, fully remote team. This critical role is responsible for overseeing the end-to-end claims process, ensuring efficiency, accuracy, and compliance with industry regulations and company policies. The ideal candidate will have extensive experience in managing complex insurance claims across various lines of business, including but not limited to property, casualty, and health insurance. You will lead a team of claims adjusters and investigators, providing guidance, training, and performance management. Key responsibilities include reviewing and approving high-value claims, identifying potential fraud, and developing strategies to mitigate risk and improve claim outcomes. As a remote leader, you will leverage advanced communication and collaboration tools to effectively manage your team and liaise with policyholders, legal counsel, and other stakeholders. A strong analytical mindset, meticulous attention to detail, and exceptional problem-solving skills are essential. You will be responsible for analyzing claims data to identify trends, inefficiencies, and opportunities for process improvement. The development and implementation of best practices for claims handling, documentation, and customer service will be a core focus. This position requires a deep understanding of insurance principles, legal frameworks, and underwriting guidelines. The ability to interpret policy wordings and apply them to specific claim scenarios is vital. We are looking for a proactive individual who can foster a culture of excellence and continuous improvement within the claims department, all within a remote work environment. This is an excellent opportunity to take on a leadership position within a growing organization and significantly contribute to its success. The designated work location for this role is within the expansive region of Garissa, Garissa, KE , however, the role is performed entirely remotely.
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2
Senior Claims Analyst - Complex Claims
Posted 2 days ago
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Job Description
Our client, a distinguished leader in the insurance sector, is seeking an experienced Senior Claims Analyst with expertise in handling complex claims to join their fully remote team. This pivotal role involves the meticulous evaluation, negotiation, and resolution of high-value and intricate insurance claims across various lines of business. As a remote-first organization, we provide a flexible and efficient virtual workspace, enabling our team members to excel from any location. You will be instrumental in ensuring fair and timely claim settlements while upholding the integrity of our client's services.
Responsibilities:
Responsibilities:
- Investigate, analyze, and adjudicate complex insurance claims, including liability assessment, coverage interpretation, and damage evaluation.
- Conduct thorough reviews of policy documents, incident reports, legal filings, and other relevant documentation.
- Negotiate settlements with claimants, legal representatives, and other stakeholders, striving for fair and equitable resolutions.
- Collaborate with internal legal counsel, investigators, and subject matter experts to manage claim lifecycles effectively.
- Identify potential fraud indicators and escalate suspicious claims for further investigation.
- Ensure compliance with all relevant insurance laws, regulations, and company policies.
- Maintain accurate and detailed claim records in the claims management system.
- Provide clear and timely communication to policyholders, agents, and other parties involved in the claims process.
- Develop and implement best practices for complex claims handling to improve efficiency and customer satisfaction.
- Mentor and guide junior claims adjusters and analysts on complex case management.
- Stay updated on industry trends, legislative changes, and emerging risks that may impact claims operations.
- Bachelor's degree in Business Administration, Finance, Law, or a related field.
- Minimum of 6 years of experience in insurance claims handling, with a significant focus on complex claims (e.g., commercial property, general liability, auto physical damage, workers' compensation).
- In-depth knowledge of insurance policies, claims investigation techniques, and settlement practices.
- Proven ability to interpret policy language, assess liability, and negotiate effectively.
- Strong analytical, problem-solving, and decision-making skills.
- Excellent written and verbal communication skills, with the ability to articulate complex issues clearly.
- Proficiency with claims management software and standard office productivity tools.
- Demonstrated ability to work independently, manage a demanding caseload, and maintain high productivity in a remote setting.
- Relevant professional designations (e.g., AIC, CPCU, ARM) are highly desirable.
- Adaptability and a commitment to continuous professional development.
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3
Senior Claims Resolution Specialist
Posted 1 day ago
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Job Description
Our client is seeking a highly experienced and motivated Senior Claims Resolution Specialist to join their dynamic, fully remote team. This role is crucial for ensuring the efficient and accurate processing and settlement of complex insurance claims across various lines of business. You will be responsible for investigating claims, determining coverage, negotiating settlements, and maintaining detailed records, all while upholding the highest standards of customer service and compliance. The ideal candidate will possess a deep understanding of insurance policies, claims procedures, and relevant legislation.
Responsibilities:
Responsibilities:
- Conduct thorough investigations into complex insurance claims, gathering all necessary documentation and evidence.
- Interpret policy language and conditions to determine coverage and liability.
- Communicate effectively with policyholders, claimants, legal representatives, and other stakeholders to gather information and explain claim status.
- Negotiate settlements within authorized limits, ensuring fairness and accuracy.
- Approve and process claim payments, managing financial exposure and preventing fraudulent activity.
- Prepare detailed reports on claim investigations, findings, and resolutions.
- Collaborate with underwriting, legal, and other departments to resolve claim issues.
- Stay updated on industry trends, regulations, and best practices in claims management.
- Mentor and provide guidance to junior claims adjusters.
- Contribute to the continuous improvement of claims handling processes and procedures.
- Bachelor's degree in Business Administration, Finance, Law, or a related field.
- Minimum of 5 years of experience in insurance claims handling, with a focus on complex claims.
- Proven ability to interpret and apply insurance policy terms and conditions.
- Excellent analytical, problem-solving, and negotiation skills.
- Strong written and verbal communication skills, with the ability to articulate complex information clearly.
- Proficiency in claims management software and Microsoft Office Suite.
- Ability to work independently and manage a caseload effectively in a remote environment.
- Professional certifications such as ACII or equivalent are a strong advantage.
- Demonstrated ability to handle sensitive information with discretion and integrity.
- A commitment to delivering exceptional customer service.
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4
Remote Claims Adjuster Specialist
Posted 1 day ago
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Job Description
Our client, a reputable insurance provider, is seeking an experienced and detail-oriented Remote Claims Adjuster Specialist to join their dedicated claims department. This position is entirely remote, allowing you to manage claims investigations and settlements from anywhere. The successful candidate will be responsible for evaluating insurance claims, determining coverage based on policy terms, and negotiating fair settlements with policyholders. You will conduct thorough investigations, which may include reviewing documentation, interviewing claimants and witnesses, and assessing damages. A strong understanding of insurance policies, legal and regulatory requirements, and claims handling best practices is essential. Excellent communication, negotiation, and customer service skills are paramount, as you will interact extensively with clients, legal professionals, and other stakeholders. You will maintain accurate and detailed records of all claim activities, ensuring timely processing and adherence to departmental protocols. The ability to work independently, manage a caseload efficiently, and make sound judgments under pressure is crucial. Proficiency with claims management software and other relevant technologies is required. This role offers a challenging and rewarding opportunity to contribute to the company's commitment to excellent customer service and efficient claims resolution. You will play a vital role in ensuring that our clients receive fair and timely settlements during their times of need. We are looking for a proactive individual who can adapt to evolving insurance landscapes and contribute to a positive remote working environment. Your expertise will be instrumental in upholding the integrity and reputation of our insurance services. This is a fantastic opportunity for a seasoned professional to leverage their claims handling skills in a flexible, remote setting.
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