Claims Consultant

Ithemba Recruitment- Sourcing Top Talent; Gqeberha; On-site; ZAR 300 000 - 400 000; Full time

Job summary

A recruitment agency is looking for a skilled claims administrator based in Gqeberha. In this role, you will provide efficient claims advice and manage the complete claims process according to company standards. You are expected to communicate effectively with clients and insurers while ensuring productivity targets are met. If you have a strong focus on client satisfaction and possess great interpersonal skills, this opportunity may be perfect for you.

Responsibilities

• Provide efficient claims advice to stakeholders.
• Adhere to quality standards and regulatory frameworks.
• Administer claims process until settlement.
• Keep internal systems and records up to date.
• Act as intermediary between insurer and client.

Job description

To provide stakeholders (e.g. clients, account executives) with efficient claims advice and administration according to the required standards and procedures in support of the business strategy.

PERSPECTIVE OUTPUTS

• Ensure appropriate minimisation of claims and claims expenses.
• Ensure and contribute to minimisation of general expenses.
• Ensure that all stakeholder (e.g. clients, insurers) communication is accurate, time‑o‑us, professional and relevant.
• Build and maintain mutually beneficial relationships with internal (e.g. account executives) and external (e.g. clients) stakeholders.
• Keep client informed regarding progression of the claim.
• Ensure and contribute to achieving the required client satisfaction targets.

Business Processes

• Adhere to company quality standards and broader regulatory frameworks for claims administration processes.
• Receive claims notification, and send and obtain any relevant forms or documents as may be required.
• Administer complete claims process according to defined claims procedures until claims are settled.
• Appoint assessor or loss adjuster and apply policy terms and conditions.
• Keep internal system and records up to date at all times.
• Keep relevant internal stakeholders up to date on the progress of registered claims.
• Make assessment of claims validity and estimate value and administer mandated claims.
• Forward claims in excess of mandate to insurer.
• Arrange approval and payment for claims costs in line with claims and cover.
• Act as intermediary between insurer and client and time‑ly relay communication, requests and documentation.
• Follow the recoveries process, daily follow‑ups and keep clients informed.
• Ensure productivity targets are met.
• Contribute towards and ensure continuous improvement in own and team performance.
• Adhere to company mandates, participate and contribute in ad‑hoc projects, report any suspected fraud, misrepresentation and/or dishonesty, keep accurate record of own activities.