Claims Assessor

MVIA; Wes-Kaap; On-site; ZAR 180,000 - 320,000; Full time

Job summary

MVIA is seeking a Claims Fast Track Assessor who can read files quickly, apply policy terms accurately, and decide confidently within mandate to keep customers supported.

You will assess, validate and settle claims fairly in line with policy, regulatory requirements and service level agreements, while delivering an excellent customer experience.

Join a team focused on continuous improvement, accuracy, timely communication with customers and brokers, and efficient finalisation of claims.

Responsibilities

• Conduct assessments against established standards, policies and regulatory requirements, reviewing documentation and records to provide quick outcomes.
• Gather and analyse evidence to support assessment findings.
• Validate cover, policy terms, conditions, exclusions and premium status before making a decision.
• Determine liability and quantum on claims and settle within the delegated mandate.
• Refer claims to the Claims Team Leader or Claims Manager when required in a timely manner.
• Identify and escape potential fraud indicators, misrepresentation or non-disclosure accordingly.
• Ensure services meet organisational, contractual and regulatory requirements.
• Identify non-compliance, recommend corrective action and monitor implementation of improvement plans.
• Apply the Treating Customers Fairly (TCF) outcomes to every claim decision and ensure decisions are consistent and defensible.
• Work within delegated authority at all times and keep claim reserves accurate and current.
• Prepare documentation and maintain accurate and confidential records.
• Track trends and recurring issues.
• Record all decisions, rationale and customer interactions on the claims system in full and in real time.
• Communicate claim outcomes to customers, brokers and intermediaries promptly.
• Manage expectations proactively on timelines, documentation requirements and next steps.
• Liaise with service providers, suppliers, assessors and repairers to expedite claim finalisation and control costs.
• Resolve queries at first point of contact wherever possible and manage complaints in line with the complaints procedure.
• Ensure continuous accurate assessment, correct application of policy and effective supplier negotiation.
• Share recurring themes and process friction points with the Team Leader to inform system and process enhancements.
• Identify opportunities to improve in service delivery and oeprational efficiency.

Job description

We are looking for a Claims Fast Track Assessor who reads a file quickly, applies policy accurately, decides confidently within mandate, and leaves the customer feeling properly looked after. The Claims Fast Track Assessor assesses, validates and settles claims accurately, fairly and in line with company policy, regulatory requirements and service level agreements, while delivering an excellent customer experience.

Assessment & Evaluation

• Conduct assessments against established standards, policies and regulatory requirements, reviewing documentation and records to provide quick outcomes.
• Gather and analyse evidence to support assessment findings.
• Validate cover, policy terms, conditions, exclusions and premium status before making a decision.
• Determine liability and quantum on claims and settle within the delegated mandate.
• Refer claims to the Claims Team Leader or Claims Manager when required in a timely manner.
• Identify and escape potential fraud indicators, misrepresentation or non-disclosure accordingly.

Compliance & Quality Assurance

• Ensure services meet organisational, contractual and regulatory requirements.
• Identify non-compliance, recommend corrective action and monitor implementation of improvement plans.
• Apply the Treating Customers Fairly (TCF) outcomes to every claim decision and ensure decisions are consistent and defensible.
• Work within delegated authority at all times and keep claim reserves accurate and current.

Reporting & Documentation

• Prepare documentation and maintain accurate and confidential records.
• Track trends and recurring issues.
• Record all decisions, rationale and customer interactions on the claims system in full and in real time.

Customer Experience & Stakeholder Liaison

• Communicate claim outcomes to customers, brokers and intermediaries promptly.
• Manage expectations proactively on timelines, documentation requirements and next steps.
• Liaise with service providers, suppliers, assessors and repairers to expedite claim finalisation and control costs.
• Resolve queries at first point of contact wherever possible and manage complaints in line with the complaints procedure.

Continuous Improvement

• Ensure continuous accurate assessment, correct application of policy and effective supplier negotiation.
• Share recurring themes and process friction points with the Team Leader to inform system and process enhancements.
• Identify opportunities to improve in service delivery and oeprational efficiency.