Claims and Complaints Manager

Job Description

Position : Claims and Complaints ManagerSection : General InsuranceCompany : Al Koot Insurance & Reinsurance CompanyLocation : Doha, QatarNo of resources : 1ROLE PURPOSE:Responsible for Al Koot?s Claims Function, i.e. settling all claims accurately and in timely manner and recover reinsurance claim amounts from reinsurers, and ensuring adherence to the claim policies and procedures, in order to achieve Al Koot?s set goals and objectives. The Claims Manager will examine, assess and process claims, ensure that payments and settlements have been made by reviewing settled insurance claims, and report any over-payments, underpayments and other irregularities.KEY ACCOUNTABILITIES:Policies, Systems, Processes & Procedures

• Develop, iterate, document and execute claims strategies taking into account uncertainties, key decisions, potential outcomes and estimated associated costs.
• Establish Al Koot?s claims management policies and procedures based on the company?s business plan, Claims Strategy and objectives.
• Set, in accordance with, the Chief Officer General Insurance and the Business Planning and Performance Management Department, performance standards/ objectives and Key Performance Indicators, for performance monitoring and quality measurement purposes for the Claims Department

Reinsurance Recovery

• Provide initial notices to the Reinsurance Function, to assist in establishing the reinsurance strategy as required by treaty.
• Ensure efficient and timely correspondence with reinsurers updating them periodically on all General Insurance Claims for smooth processing and recovery of claims.
• Ensure all reinsurers queries are accurately addressed.

Claims Management / Analysis

• Proactively manage claims from notification to closure, investing the necessary level of involvement required for each claim depending on, the nature, category, maturity, type and importance of the claim.
• Supervise and approve claim processing, within authorized limits
• Periodically update senior management with the claims trends in order to make aware of the financial status and to facilitate ease of decision-making.
• Coordinate with Actuary & Finance in reviewing calculation of Incurred but Not Reported claims (IBNR).
• Resolve complex, severe exposure claims, using high service Consultants, if required.

Procedure Compliance

• Ensure compliance with all department procedures as well as requirements of the statutory auditors / ISO Auditors / Internal Auditor to avoid any violations.
• Ensure Compliance with QCB regulations
• Ensure timely coordination with Legal and Compliance on claims requiring litigation.

Service Provider Compliance

• Supervise reviewing all claims and coordinate with service providers as appropriate in order to facilitate timely payments / processing of all claims for all companies as well as Collect / provide necessary documents as appropriate.

Loss Adjuster Reports

• Develop and maintain clear investigation and verification procedures for claims.
• Monitor the adherence to claims investigations procedures.
• Scrutinise all loss adjuster reports to ensure the claims are genuine and in line with policy terms and conditions

System updates

• Ensure all claims are registered, managed and settled through the system to facilitate generating of reports as per management requirements.

Complaints and Grievances

• Responsible for complaints and grievances raised against the company
• Ensure that procedures for complaints and grievances are well known to the insureds.
• Declare monthly complaints and grievances received to QCB
• Follow-up complaints and grievances for closure

Keyskills :