Claims and Benefits Officer

Job Description

The Claims and Benefits Officer is responsible for end-to-end processing of Group Life and Credit Life claims, ensuring accurate assessment, efficient processing, and exceptional service delivery. The role ensures adherence to policy terms, internal claims guidelines, regulatory standards, and risk mitigation practices, supporting the integrity and sustainability of the corporate claims function.

KEY TASKS AND RESPONSIBILITIES

• Register and acknowledge claims within agreed timelines and ensure completeness of claim documentation
• Perform claims assessment in line with policy terms, underwriting notes, and applicable reinsurance arrangements
• Prepare claim summaries and recommendations for approval based on internal authority limits
• Coordinate with internal stakeholders (underwriting, reinsurance, legal) to support accurate and defensible claims decisions
• Follow up with clients, brokers, or medical providers to resolve outstanding requirements or clarifications
• Ensure timely communication of claim outcomes to clients and intermediaries with empathy and professionalism
• Track and maintain claims registers and contribute to analysis of claims experience and turnaround performance
• Support escalations and contribute to reviews of declined or disputed claims by compiling supporting evidence
• Ensure claims handling activities fully comply with internal claims guidelines, Anti-Money Laundering (AML) regulations, Data Protection Act (DPA), and Insurance Regulatory Authority (IRA) claims handling expectations
• Conduct beneficiary verification and escalate suspicious claims in line with AML/CFT policy
• Ensure confidentiality of personal and medical data is maintained at all times

SKILLS AND COMPETENCIES

• Strong knowledge of life insurance claims principles and policy interpretation
• High attention to detail and accuracy in claims documentation
• Empathy and emotional intelligence when dealing with bereaved clients
• Analytical and problem-solving capabilities in adjudicating complex claims
• Good written communication and reporting skills
• Team player with ability to coordinate across departments under pressure

KNOWLEDGE & EXPERIENCE

• 2–3 years’ experience handling group life or credit life claims

QUALIFICATIONS

• Bachelor’s degree in Commerce (BCOM), or a business-related field
• Professional insurance qualification (e.g., AIIK, ACII, LOMA)