Your: Formal Education: Matric Relevant NQF 5 Successfully completed the RE 5 Examination Level 1 Experience: A minimum of three (3) years Claims experience with a claims settling mandate A minimum of five (5) years working experience within the Short Term Insurance industry will enable you to do the following duties: Processes: Effectively maintain claims standards and provide quality client service: Register motor / non motor claims for personal and commercial policies Appoint assessors Confirm and make sure that cover is sufficient Responsible for handling of and settling of claims for clients allocated and ensuring accurate capturing and updating on all data systems Manage the claim from start through to settlement stage Gathering information about the insurance claim from the client and any others involved Examining the details on completed forms and checking these against the cover provided by the insurance policy Consulting with other staff to decide the outcome of the claim and any compensation to be paid Informing the client of the outcome of the claim in writing Referring large or complex claims to other professionals such as a loss adjuster Determine merits based on facts and investigation of reports presented Settle claims within set parameters to avoid leakage Obtain all information required for settlement or rejection of claims Do continuous adjustments of reserves Arrange / deal with the fulfilment of the following: Car hire for insured in the event of an accident where vehicle not drivable or of car has been stolen Arrange contractors to assist insured with obtaining critical documents to support claim Manage salvage process motor & non-motor salvage right through to recovery payment received Follow up with loss adjustors/assessors periodically/ daily if required Ability to negotiate claims with clients, service providers and Insurance market Keep detailed, dated file notes of all discussions on the claim files Ability to negotiate contentious claim with Insurance market and clients Potential errors and omissions must be immediately referred to Claims Manager Responsible for completion of claim files upon finalisation of claim and do filing to EDS Ensure that claims files are maintained in accordance with operational standard and company procedures Daily system updates (Such as diary & daily mail) Detail Prompt feedback and handling of complaints (internal & external) Ensure resolution of queries and complaints speedily To submit and provide insurer feedback & reports as per agreed timelines Ensure a pleasant claims experience Facilitate and maintain sound working relationships with clients, colleagues, markets, and service providers, including but not limited to local markets Ensure policy maintenance after a claim is completed Update underwriting of items to be deleted/replaced Maintain records of all reports submitted to clients.
People: Service delivery to ensure customer satisfaction: Maintain service, quality and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures and standards Resolve escalated customer queries and complaints and provide feedback to customers on matters resolved Develop work routines in line with operational plans / schedules in order to manage achievement of service Delivery goals Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.
Maintain effective people practices: Align own behaviour with the organization culture and values Share and transfer product, process and systems knowledge to colleagues Collaborate and work with the Claims team to ensure required service levels are delivered.
Technology: Continuous improvement to ensure effective service: Ensure adherence to organizational policies, practices and procedures Identify and recommend areas / ways to improve processes DOFA confirmation from FSB Cardinal 360 system experience will be an advantage.
