Claims Manager – General Business job at CIC Insurance Group PLC

CIC Insurance Group is a leading insurance and financial services organisation with more than five decades of experience helping individuals, families, and organizations achieve financial security.

We have grown into a dynamic Group offering life, general, micro insurance, asset management, and investment solutions, with operations in Kenya, Uganda, South Sudan, and Malawi, and are listed on the Nairobi Securities Exchange.

Our tagline, “We Keep Our Word,” reflects our unwavering commitment to integrity, transparency, and delivering on our promises to our clients, partners, and communities.

CIC Group is passionate about innovation, digital transformation, and inclusive insurance solutions that meet the evolving needs of cooperatives, SMEs, corporates, and individuals. By joining us, you will be part of a team that is shaping the future of financial protection across Africa.

About the Role

Reporting to the Chief Executive Officer, the role will support the effective and efficient management of the GB insurance claims function by ensuring accurate, timely, and fair assessment and settlement of claims; maintaining prudent and adequate reserving; ensuring full compliance with regulatory, policy, and governance requirements; and driving continuous improvement in claims processes, service delivery, and operational controls, while providing strong leadership, guidance, and professional development to the claims team.

Key Responsibilities:

Claims Approval & Settlement

• Provide technical oversight and approval of GB insurance claims discharge documentation within delegated authority levels.
• Authorise payment of GB claims strictly in line with policy provisions, underwriting intent, reinsurance requirements, regulatory rules, and internal governance frameworks.
• Ensure all GB claims are assessed, approved, and settled accurately, fairly, and within agreed turnaround times (TATs).
• Exercise sound judgment to ensure settlements reflect policy intent while safeguarding the company against financial, legal, and reputational risk.
• Review and validate complex claims assessments to ensure alignment with medical evidence, legal documentation, underwriting disclosures, and contractual obligations.
• Escalate high‑risk, high‑value, complex, or contentious claims with comprehensive analysis, risk assessment, and clearly articulated recommendations.

Claims Reserving & Review

• Establish, review, and adjust GB claim reserves based on evolving claim facts, legal outcomes, and exposure assessments.
• Ensure reserves accurately reflect the ultimate liability and comply with actuarial input, accounting standards, and regulatory requirements.
• Monitor reserve adequacy and trends to minimise reserve volatility and financial misstatement.
• Conduct structured periodic reserve reviews, providing clear justification for material adjustments, strengthening overall portfolio transparency and control.
• Collaborate with actuarial and finance teams to enhance reserving accuracy and claims provisioning discipline.

Risk Management & Underwriting Support

• Analyse GB claims experience, including morbidity, loss ratios, and emerging risk trends.
• Identify systemic issues, root causes, anti‑selection risks, and control gaps impacting portfolio performance.
• Provide targeted, data‑driven feedback to underwriting, pricing, and product teams to improve risk selection, pricing adequacy, and policy wording clarity.
• Support continuous enhancement of underwriting guidelines leveraging claims insights and lessons learned.
• Participate in post‑loss reviews, evaluations, investigations, and technical assessments.

Customer Service & Complaints Handling

• Champion fair and transparent claims handling in line with Treating Customers Fairly (TCF) principles.
• Manage escalated, sensitive, or complex claims complaints involving beneficiaries, policyholders, intermediaries, and regulators.
• Ensure professional, timely, and well‑documented communication at all stages of the claims journey.
• Build and maintain strong professional relationships with brokers, agents, reinsurers.
• Strengthen trust and brand reputation through balanced, customer‑centric, yet contractually sound decision‑making.

Regulatory, Governance & Management Reporting

• Prepare, validate, and submit accurate GB claims returns and reports to the Insurance Regulatory Authority (IRA) within prescribed timelines.
• Ensure compliance with all statutory, regulatory, reinsurance, and internal reporting standards.
• Maintain high standards of data integrity, documentation quality, and audit readiness.
• Support internal, external, and regulatory audits by providing clear explanations, reconciliations, and corrective action plans.
• Produce insightful management reports highlighting claims performance, risk exposures, trends, operational efficiency, and emerging issues.

Appeals & Ex‑Gratia Claims Management

• Coordinate preparation and presentation of claim appeals and ex‑gratia requests to management, relevant or committees.
• Ensure all ex‑gratia settlements are justified, exceptional, fully documented, and aligned with approved governance frameworks.
• Track appeal outcomes and identify systemic lessons to enhance decision‑making consistency and reduce recurrence.
• Strengthen transparency and accountability in exceptional claims handling.

People Management & Development

• Provide strong leadership, supervision, and mentorship to GB claims teams.
• Set performance standards aligned to quality, turnaround time, customer experience, and technical excellence.
• Conduct structured performance reviews and implement targeted development and succession plans.
• Allocate workloads effectively and monitor productivity to ensure service and quality benchmarks are consistently achieved.
• Foster a culture of professionalism, ethical conduct, accountability, collaboration, and continuous improvement.

Decision‑Making & Accountabilities

Financial Impact Decisions

• Approve life claim payments within delegated authority limits.
• Provide expert technical input into declined, disputed, negotiated, appealed, and ex‑gratia claims.
• Influence claims cost containment, reserve adequacy, loss ratios, and overall product profitability.
• Contribute to life claims budgeting, forecasting, and expense management initiatives.

Operational, Customer & People Impact Decisions

• Communicate claim decisions clearly, professionally, and sensitively to policyholders, beneficiaries, and intermediaries.
• Drive continuous improvement of GB claims processes, controls, systems, and workflows.
• Coach and guide staff to enhance technical competence and decision quality.
• Ensure consistent adherence to service standards, ethical principles, regulatory requirements, and internal policies.

Who We’re Looking For

Essential Knowledge/Skills and Experience Required:

• Bachelor’s degree in Actuarial, Business Administration or a related discipline.
• Professional insurance qualification such as ACII, CII, Diploma in Insurance
• Masters Degree in related field is an added advantage.
• Minimum of 8 years’ experience in claims Management.

• Provide technical oversight and approval of GB insurance claims discharge documentation within delegated authority levels.
• Authorise payment of GB claims strictly in line with policy provisions, underwriting intent, reinsurance requirements, regulatory rules, and internal governance frameworks.
• Ensure all GB claims are assessed, approved, and settled accurately, fairly, and within agreed turnaround times (TATs).
• Exercise sound judgment to ensure settlements reflect policy intent while safeguarding the company against financial, legal, and reputational risk.
• Review and validate complex claims assessments to ensure alignment with medical evidence, legal documentation, underwriting disclosures, and contractual obligations.
• Escalate high‑risk, high‑value, complex, or contentious claims with comprehensive analysis, risk assessment, and clearly articulated recommendations.
• Establish, review, and adjust GB claim reserves based on evolving claim facts, legal outcomes, and exposure assessments.
• Ensure reserves accurately reflect the ultimate liability and comply with actuarial input, accounting standards, and regulatory requirements.
• Monitor reserve adequacy and trends to minimise reserve volatility and financial misstatement.
• Conduct structured periodic reserve reviews, providing clear justification for material adjustments, strengthening overall portfolio transparency and control.
• Collaborate with actuarial and finance teams to enhance reserving accuracy and claims provisioning discipline.
• Analyse GB claims experience, including morbidity, loss ratios, and emerging risk trends.
• Identify systemic issues, root causes, anti‑selection risks, and control gaps impacting portfolio performance.
• Provide targeted, data‑driven feedback to underwriting, pricing, and product teams to improve risk selection, pricing adequacy, and policy wording clarity.
• Support continuous enhancement of underwriting guidelines leveraging claims insights and lessons learned.
• Participate in post‑loss reviews, evaluations, investigations, and technical assessments.
• Champion fair and transparent claims handling in line with Treating Customers Fairly (TCF) principles.
• Manage escalated, sensitive, or complex claims complaints involving beneficiaries, policyholders, intermediaries, and regulators.
• Ensure professional, timely, and well‑documented communication at all stages of the claims journey.
• Build and maintain strong professional relationships with brokers, agents, reinsurers.
• Strengthen trust and brand reputation through balanced, customer‑centric, yet contractually sound decision‑making.
• Prepare, validate, and submit accurate GB claims returns and reports to the Insurance Regulatory Authority (IRA) within prescribed timelines.
• Ensure compliance with all statutory, regulatory, reinsurance, and internal reporting standards.
• Maintain high standards of data integrity, documentation quality, and audit readiness.
• Support internal, external, and regulatory audits by providing clear explanations, reconciliations, and corrective action plans.
• Produce insightful management reports highlighting claims performance, risk exposures, trends, operational efficiency, and emerging issues.
• Coordinate preparation and presentation of claim appeals and ex‑gratia requests to management, relevant or committees.
• Ensure all ex‑gratia settlements are justified, exceptional, fully documented, and aligned with approved governance frameworks.
• Track appeal outcomes and identify systemic lessons to enhance decision‑making consistency and reduce recurrence.
• Strengthen transparency and accountability in exceptional claims handling.
• Provide strong leadership, supervision, and mentorship to GB claims teams.
• Set performance standards aligned to quality, turnaround time, customer experience, and technical excellence.
• Conduct structured performance reviews and implement targeted development and succession plans.
• Allocate workloads effectively and monitor productivity to ensure service and quality benchmarks are consistently achieved.
• Foster a culture of professionalism, ethical conduct, accountability, collaboration, and continuous improvement.
• Approve life claim payments within delegated authority limits.
• Provide expert technical input into declined, disputed, negotiated, appealed, and ex‑gratia claims.
• Influence claims cost containment, reserve adequacy, loss ratios, and overall product profitability.
• Contribute to life claims budgeting, forecasting, and expense management initiatives.
• Communicate claim decisions clearly, professionally, and sensitively to policyholders, beneficiaries, and intermediaries.
• Drive continuous improvement of GB claims processes, controls, systems, and workflows.
• Coach and guide staff to enhance technical competence and decision quality.
• Ensure consistent adherence to service standards, ethical principles, regulatory requirements, and internal policies.

• Technical claims oversight, assessment, approval, and settlement
• Claims reserving, reserve adequacy review, and provisioning
• Claims risk analysis, loss ratio analysis, and identification of emerging trends
• Underwriting, pricing, and product feedback based on claims insights
• Customer service, complaints handling, and sensitive communication
• Regulatory compliance, reporting, audit readiness, and data integrity
• Claims appeals and ex‑gratia management
• Leadership, supervision, mentorship, and team development
• Management reporting, budgeting, forecasting, and expense management
• Sound judgment, ethical conduct, and risk management

• Bachelor’s degree in Actuarial, Business Administration or a related discipline.
• Professional insurance qualification such as ACII, CII, Diploma in Insurance
• Masters Degree in related field is an added advantage.