PURPOSE OF THE JOB

The job holder will be responsible for evaluating and advising the company regarding actuarial reserving, premium pricing activities, experience investigations, product reviews, solvency, and capital management as well as monitoring and advising on compliance with regulatory requirements.

PRINCIPAL ACCOUNTABILITIES

• Reserving - Conduct and/or review internal actuarial liability valuations and provide advice on the company’s actuarial and financial risks
• Product Profitability Review: Support product development processes, Perform profitability analysis, experience analysis, and other relevant actuarial investigations to inform business decisions.
• Solvency and Capital management; Carry out solvency computations for the business based on a risk-based capital including solvency stress tests.
• Financial Modeling: assist with financial modeling of business scenarios/projects to inform business decision making.
• Strategy and Business Planning Support; assist with business planning financial projections and solvency projections. Perform stress and scenario analysis on the plan numbers.
• Special Projects; participate in special projects as would be requested by the company e.g. IFRS17, system implementation and mapping out of OPEX Standard Operating Procedures.
• Reinsurance Support; Carry out a reinsurance analysis to explore ways to optimize on reinsurance arrangements
• Reporting and Documentation; Presentation of results and reports to the businesses. Preparation of Board Papers and regulatory solvency and valuation reports
• Risk Management support; assist the business in identifying, quantifying risk (insurance, market, credit risks etc.) where appropriate. Formulate appropriate risk mitigation measures and develop/update a risk register.
• Investment Strategy support; Support the formulation of appropriate investment strategies and/or review and monitoring of investment strategies.

Other reasonable duties that may be assigned by management

KNOWLEDGE AND EXPERIENCE

Qualifications:

• Bachelor’s Degree in actuarial science or other related finance or mathematics degree
• Actuarial Knowledge: Qualified actuary, Nearly qualified, 10 papers and above

Experience:

• Minimum of 5( five) years’ experience with at least 2(two) years at supervisory role.

Knowledge

• Understanding of insurance industry
• Clear understanding of accounting standards
• Practical/technical experience in Finance & Accounting

SKILLS AND COMPETENCIES

• Familiar with the current Insurance regulations, Capital markets and IRA regulations
• Strong actuarial technical skills
• Problem solving skills
• Creative thinking
• Relationship building
• Team-working
• Leading and developing others
• Strategic perspective

MAIN DUTIES AND RESPONSIBILITIES

Claims Processing

• Confirmation of membership, validity, and benefits before processing claims.
• Capture and vet medical bills within the clients benefit structure.
• Code, verify, audit and process medical claims within negotiated, customary and reasonable price.
• Correctly reserve bills on discharge and approved outpatient cases.
• Provide second review of bills where providers question the appropriateness of payment authorized.
• Process reimbursement documents and communicate to clients about the status of their claims.

Care Management

• Receive and respond to Medical emergency lines and ensure 24 hour coverage.
• Review pre-authorization of admission, discharges, scheduled and emergency medical cases, issue timely responses as per policy benefits and company guidelines.
• Review of patient’s history and records to determine cause of disease and assess if treatment correlates with the diagnosis and applicable benefits.
• Coordinate local and international emergency evacuations, referrals, and transfers
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration) and ensure their compliance.
• Negotiation of doctors’ and hospital bills and charges in view of reducing the cost of care before or during admissions.
• Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi to ensure quality of care and cost containment. Post discharge follow up of patients to ensure adherence to care.
• Send weekly and monthly report on admissions, exceptional claims, long stay, savings amongst others.

Customer Service

• Oversee weekly sending out active members list to the providers.
• Update intermediaries and/ or scheme administrators on clinical, coverage and bills of admitted clients.
• Provide feedback and update to intermediaries and schemes on requested providers.
• Coordinate with the clients and medical providers to leverage on NHIF.
• Ensure adherence to contracts and service level agreements between providers and the company.
• Register, follow through and resolve the customers and provider queries and complains in time and advise them on outcome and the details of the medical product.

KNOWLEDGE AND EXPERIENCE

Academic Qualification

• Bachelor’s degree in Nursing/ Diploma in Nursing

Professional Qualifications

• Nursing Council of Kenya
• AIIK

Experience

• Four years’ experience in health insurance

Knowledge

• Understanding of insurance industry

SKILLS AND COMPETENCIES

• Excellent communication and Interpersonal Skills.
• Problem Solving
• Empathy
• Decision Making
• Negotiation Skills
• Ethical
• Team Player
• Keen to detail
• Planning & Organization Skills
• Customer Oriented
• Stakeholder management
• Dependability

PURPOSE OF THE JOB

To implement the company document management policy, to ensure that all records are properly secured, referenced, stored and available when needed in line with the company regulations and policies.

MAIN DUTIES AND RESPONSIBILITIES

• Interpreting and implementing record management policies;
• Developing and implementing record management systems standards of services;
• Applying appropriate technology in creation, retrieval, storage, archiving and sharing of documents to enable efficient use by relevant officers;
• Ensuring reception, scanning and registering all incoming mail and distribute to relevant departments and staff, and filing of hard copies in respective files;
• Ensuring all enquiries regarding records from users are resolved.
• Ensuring the maintenance of a record of all file movements and ensure that all files requested for from the registry/warehouse are returned within the set time;
• Participate in classifying and of archived files weeding and disposal;
• Facilitate speedy classification of all new policy files received in the registry.
• Monitor the EDMS team’s work and ensure quality standards are adhered;
• Process an effective file retention schedule;
• Facilitating borrowing and transferring of documents to/from the Registry to the warehouse.
• Ensuring the security and confidentiality of files and documents within the office archive;
• Prepare records management periodic reports.
• Coaching and mentoring the records management team;
• Conducting periodic current awareness trainings to all company staff and inducting new staff on Records management healthy practices.
• Maintain updated and accurate inventories of all archived files adherence to the records retention policy;

KNOWLEDGE AND EXPERIENCE

Qualifications

• A Degree in Records Management, Information Sciences or Library Science from a recognized institution.

Experience

• At least four (4) years relevant work experience in a similar role
• Insurance industry operations experience has an added advantage

Knowledge

• Digital/electronic document management system operations
• Computer skills
• Records Management
• RM Acts Interpretation and RM policy implementation.

SKILLS AND COMPETENCIES

• Pro-active
• Accuracy
• Interpersonal skills
• Confidentiality
• Coaching skills