Claims Consultant

PPS; Johannesburg; On-site; ZAR 450,000 - 900,000; Full time

Job summary

PPS seeks an experienced claims co-ordinator to oversee personal lines and commercial claims from intake to settlement. You will negotiate, validate, and finalise claims while documenting every interaction in line with PPS policy terms.

Responsibilities include investigating merits, appointing assessors when needed, verifying policy requirements, and making decisions within financial mandates to ensure timely and accurate outcomes for stakeholders.

Qualifications

• 5+ years experience in a Short-Term Insurance Claims environment.
• Short-term Insurance Industry experience is advantageous.
• Codeplex experience is advantageous.

Responsibilities

• Validate claims in a friendly, courteous manner within SLAs.
• Document interactions, decisions, and transactions with accuracy.
• Investigate merits and appoint assessors when required.
• Verify that policy requirements are met (e.g. alarms).
• Make decisions within financial mandates and escalate as needed.

Skills

Communication

Customer Service

Attention to Detail

Work Ethic

Analytical Skills

Problem Solving

Adaptability

Education

Grade 12

Certificate of Proficiency

Tools

Codeplex

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.

Requirements

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.

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