Assistant Claims Manager – General job at CIC Group

Job Description

Job Summary

Reporting to the Claims Manager, the Assistant Claims Manager – General role will support the effective and efficient management of the 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 of claims processes, service delivery, and operational controls, while providing strong leadership, guidance, and development support to the claims team.

Key Duties & Responsibilities

Claims Approval & Settlement

• Review, verify, and approve discharge vouchers within delegated authority limits.
• Authorize claim payments in accordance with approved limits, policy provisions, and company guidelines.
• Ensure all claims are processed, approved, and settled accurately and within defined turnaround times (TATs).
• Monitor settlement quality to ensure alignment with underwriting intent, policy terms, and regulatory requirements.
• Escalate complex, high‑value, or contentious claims with clear recommendations and justification.

 Claims Reserving & Review

• Establish, review, and adjust reserves based on updated information, claim progression, and exposure assessments.
• Monitor reserve adequacy to ensure accurate claim provisioning and mitigate financial risk.
• Conduct periodic reserve reviews and provide explanations for material adjustments or variances.
• Ensure reserving practices adhere to internal guidelines, actuarial input, and regulatory standards.

Risk Management & Underwriting Support

• Analyse claims trends, loss ratios, and emerging risks to identify patterns, root causes, and improvement opportunities.
• Provide underwriting teams with regular claims insights to strengthen pricing, risk assessment, and product development.
• Support refinement of underwriting guidelines based on claims experience and risk issues.
• Participate in risk surveys, post‑loss assessments, and technical investigations where required.
• Appoint service providers (investigators, assessors, garages etc.) in a timely manner

 Customer Service & Complaints Handling

• Address customer, intermediary, and service provider queries and complaints related to claims.
• Ensure clear, fair, and timely communication with all stakeholders throughout the claim’s lifecycle.
• Handle sensitive, escalated, or complex complaints in line with Treating Customers Fairly (TCF) principles.
• Maintain productive relationships with brokers, agents, loss adjusters, repairers, and other service providers.

Regulatory & Management Reporting

• Prepare and submit accurate monthly claims reports to the Insurance Regulatory Authority (IRA) within stipulated timelines.
• Ensure data integrity, completeness, and compliance with statutory and internal reporting requirements.
• Support internal and external audits by providing required documentation and clarifications.
• Contribute to management reports on claims trends, performance indicators, and emerging risks.

Appeals & Ex‑Gratia Claims Management

• Coordinate the preparation and presentation of appeals and ex‑gratia requests to relevant committees.
• Ensure proper documentation, justification, and approval of all ex‑gratia settlements.
• Track appeal resolutions and extract lessons learned to improve claims processes and decision‑making.

People Management & Development

• Supervise, coach, and mentor claims staff to enhance technical competence, productivity, and service excellence.
• Conduct performance appraisals, provide structured feedback, and implement development plans.
• Allocate workloads, monitor productivity, and ensure quality and turnaround standards are consistently met.
• Foster a culture of accountability, teamwork, ethical conduct, and continuous improvement.

Decision‑Making & Accountabilities

 Financial Impact Decisions

• Provide input into claims department planning, budgeting, and cost‑control initiatives.
• Approve claim settlements within delegated authority levels.
• Offer expert recommendations on declined, disputed, or negotiated claims.
• Influence loss control measures, reserving accuracy, and overall claims cost management effectiveness.

 Process, Customer & People Impact Decisions

• Communicate claim decisions formally and professionally to clients, partners, and intermediaries.
• Identify, recommend, and implement improvements in claims handling processes and workflows.
• Provide coaching, feedback, and performance guidance to team members.
• Ensure compliance with service standards, ethical practices, regulatory requirements, and internal policies.

Educational Qualifications, Experience, & Skills Required

• Bachelor’s degree in Actuarial, Business Administration or a related discipline.
• Professional insurance qualification such as ACII, CII, Diploma in Insurance
• Minimum of 5 years’ experience in claims Management.
• Claims Technical Expertise – Strong knowledge of policy interpretation, claims assessment, settlement, and reserving practices.
• Analytical & Judgment Skills – Ability to analyse complex claims, assess risk and quantum, and make sound, fair decisions.
• Decision-Making & Accountability – Confident, timely decision-making within delegated authority with clear ownership of outcomes.
• Customer & Stakeholder Management – Professional handling of customers, intermediaries, complaints, and external service providers.
• Leadership & People Development – Ability to coach, mentor, and manage claims staff to achieve performance and quality standards.
• Planning & Time Management – Strong organization and prioritization skills to meet turnaround times and service levels.
• Communication & Reporting – Clear written and verbal communication, including regulatory and management reporting.
• Ethics, Compliance & Integrity – Commitment to ethical conduct, regulatory compliance, and Treating Customers Fairly principles.

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