Claims Consultant

PPS; Johannesburg; On-site; ZAR 180,000 - 300,000; Full time

Job summary

PPS Short-Term Insurance is seeking a claims professional to coordinate and oversee personal and commercial claims end-to-end. You will delegate authority, resolve conflicts, and ensure accuracy and efficiency in line with PPS policy terms.

The role requires strong communication, detailed record-keeping, and negotiation skills to assess merits, appoint assessors, and support service levels across stakeholders.

Qualifications

• Strong communication skills (written & verbal).
• Strong customer service 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.

Responsibilities

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

Skills

Claims handling

Customer service

Attention to detail

Communication

Problem solving

Adaptability

Education

NQF Level 4

Grade 12

Certificate of Proficiency

Job description

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.

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.

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Requirements

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Education

• NQF Level 4: Grade 12
• 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

• Strong communication skills (written & verbal).
• Strong customer service 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.

Competencies

• Adapting and responding to change.
• Persuading and influencing.
• Deciding and Initiating Action.
• Coping with pressure.

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Duties and Responsibilities

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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