Claims Consultant

PPS Recruitment; Johannesburg; On-site; ZAR 350,000 - 550,000; Full time

Job summary

PPS Short-Term Insurance Company is seeking an experienced Claims Advisor to co-ordinate and oversee personal lines and commercial claims end-to-end. You will delegate authority, manage negotiations, and finalise settlements within policy terms and service levels.

Responsibilities include validating claims, documenting interactions, and coordinating expert assessors where needed, while maintaining accuracy and high service standards.

Qualifications

• 5+ years in a Short-Term Insurance Claims environment.
• Certificate of Proficiency in related field.
• Strong attention to detail and accuracy.
• Service driven with focus on quality of information.

Responsibilities

• Validate claims in a courteous, professional manner within SLA times.
• Document all interactions, decisions and transactions related to claims.
• Assess if an assessor/loss adjustor is needed and appoint where appropriate.
• Verify policy terms compliance and required documents.

Skills

Attention to detail

Strong analytical skills

Negotiation

Adaptability

Stakeholder management

Pressure management

Education

Certificate of Proficiency in related field

Tools

Codeplex

Job description

Co-ordinate and oversee, manage negotiate and settle personal lines and commercial claims and account for the finalisation of the claim end-to-end. Delegate authority to manage the process and resolve any conflict by a negotiating, settlement, and finalisation functionality. Administer and validate claims correctly and efficiently within the specifications of PPS Short-Term Insurance Company's policy terms and conditions.

Education:

• Certificate of Proficiency in related field

Experience:

• 5+ years experience in a Short-Term Insurance Claims environment
• Short-term Insurance Industry experience will be advantageous.
• Codeplex experience would be an advantage.

Knowledge and Skills:

• Service driven, with a focus on accuracy and quality of information delivered within service levels.
• Strong attention to detail.
• A strong work ethic and a drive to exceed expectations.
• Strong analytic and problem-solving skills.
• Adaptability to different stakeholders, audiences, and environments.
• Adapting and responding to change.
• Persuading and influencing.
• Deciding and Initiating Action.
• Coping with pressure.

Duties and Responsibilities

Validation of Insurance Claims

• Validate claims in a friendly, courteous, and professional manner to all stakeholders within the prescribed turnaround times as documented and agreed in various service level agreements
• Accurately document all interactions, decisions, and transactions related to the claims process. This includes maintaining detailed records of claim documents, correspondence, and any investigation findings
• Investigate the merits of a specific claim and determine if the services of an assessor / loss adjustor would be required and appoint the most appropriate preferred assessor / loss adjustor where necessary to perform further investigations
• Verify that all requirements are met (e.g. alarm systems, etc) in terms of the policy contract
• Confirmation of conflicting statements with relevant parties
• Make decision within financial mandate and within the set-out processes

Process optimization and efficiencies

• Duties include working with cross-functional teams to deliver exceptional service to all intermediaries/members as set out in the relevant service level agreements
• Combat insurance fraud by ensuring strict compliance to mandates, set procedures, philosophies and Company rules and regulations
• Identify opportunities for process improvements and efficiency enhancements within the claims handling department. Offer feedback and suggestions to enhance customer experience and streamline operations
• Uphold all service excellence principals as communicated by management

Stakeholder Management

• Build and maintain relationships with internal and external stakeholders
• Collaborate effectively with peers to achieve business results