Annually Cost To Company (Market related)The main purpose of the Claims Specialist's role is to validate and process short-term insurance claims following a fortuitous event. Working in close partnership with an allocated portfolio of brokers, the Binder and Outsource Claims Specialist will specifically make claims validation decisions on complex and high value claims that exceed the broker's mandate (for both Motor and Non-Motor, Personal Lines and Commercial Lines).The Claims specialist will also fulfill a coaching role, assisting and guiding binder and outsource brokers to make correct claims validation determinations on all claims that fall within their defined mandate. The Claims Specialist will oversee the training and oversight of the binder and outsource brokers.Key Performance Areas:Validation of claims in line with Company guidelines and Standard Operating ProceduresManagement of Large loss and complex claimsAppointment of necessary providersAuthorizations/Settlement of claimsRejection of claimsProcessing payments within the turn-around timePayment confirmations to Brokers and SuppliersAssisting clients and brokers over the phone/email with claims and queriesRelationship Management with allocated brokers, including training of brokers with binder and outsource agreementsOversight and management of binder and outsource brokersComplaints handling and resolutionLiaising with Service ProvidersLiaising with brokers and clientsRequirements:Matric Certificate – essentialRegulatory ExamFurther Education and Training Certificate in Short-Term Insurance – NQF 4, and/or a Higher Certificate in Short term Insurance - NQF 5Class of Business certification (Personal Lines & Commercial Lines) – Highly advantageousMust be compliant with FAIS Fit and Proper requirements with track-record of working unsupervised.Marine and Engineering knowledge – Highly advantageousComputer literate – Microsoft Word, Excel, and OutlookExperience in Commercial and Personal linesAt least 5-10 years' relevant work experience in claims validations and settlement (both in Motor and Non-Motor claims, as well as in both Personal Lines and Commercial Lines classes of business)Work experience within a licensed insurer, or Underwriting Manager.Experienced in making claims settlement determinations with mandate exceeding R250 000.00Sound technical knowledge and understanding of relevant short term insurance policy wordingPlease note that only shortlisted candidates will be contacted.
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