Claims Handler Ii

Your:

Formal Education:

• Matric
• Relevant NQF 5
• Successfully completed the RE 5 Examination Level 1

Experience:

A minimum of three years Claims experience with a claims settling mandate and a minimum of five years working experience within the Short Term Insurance industry will enable you to do the following duties:

Processes:

• Effectively maintain claims standards and provide quality client service.
• Register motor/non-motor claims for personal and commercial policies.
• Appoint assessors and confirm that cover is sufficient.
• Responsible for handling and settling claims for clients allocated, ensuring accurate capturing and updating on all data systems.
• Manage the claim from start through to settlement stage.
• Gather information about the insurance claim from the client and others involved.
• Examine the details on completed forms and check these against the cover provided by the insurance policy.
• Consult with other staff to decide the outcome of the claim and any compensation to be paid.
• Inform the client of the outcome of the claim in writing.
• Refer large or complex claims to other professionals such as a loss adjuster.
• Determine merits based on facts and investigation of reports presented.
• Settle claims within set parameters to avoid leakage.
• Obtain all information required for settlement or rejection of claims.
• Do continuous adjustments of reserves.
• Arrange/deal with the fulfilment of the following:
• Car hire for insured in the event of an accident where the vehicle is not drivable or has been stolen.
• Arrange contractors to assist insured with obtaining critical documents to support claim.
• Manage salvage process for motor & non-motor salvage right through to recovery payment received.
• Follow up with loss adjustors/assessors periodically/daily if required.
• Ability to negotiate claims with clients, service providers, and the Insurance market.
• Keep detailed, dated file notes of all discussions on the claim files.
• Ability to negotiate contentious claims with the Insurance market and clients.
• Potential errors and omissions must be immediately referred to Claims Manager.
• Responsible for completion of claim files upon finalisation of claim and do filing to EDS.
• Ensure that claims files are maintained in accordance with operational standard and company procedures.
• Daily system updates (such as diary & daily mail).
• Detail prompt feedback and handling of complaints (internal & external).
• Ensure resolution of queries and complaints speedily.
• Submit and provide insurer feedback & reports as per agreed timelines.
• Ensure a pleasant claims experience.
• Facilitate and maintain sound working relationships with clients, colleagues, markets, and service providers, including but not limited to local markets.
• Ensure policy maintenance after a claim is completed.
• Update underwriting of items to be deleted/replaced.
• Maintain records of all reports submitted to clients.

People:

Service delivery to ensure customer satisfaction:

• Maintain service, quality, and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures, and standards.
• Resolve escalated customer queries and complaints and provide feedback to customers on matters resolved.
• Develop work routines in line with operational plans/schedules to manage achievement of service delivery goals.
• Share knowledge on, and participate in the creation of new standards, control systems, and procedures to maintain service delivery.

Maintain effective people practices:

• Align own behaviour with the organization culture and values.
• Share and transfer product, process, and systems knowledge to colleagues.
• Collaborate and work with the Claims team to ensure required service levels are delivered.

Technology:

Continuous improvement to ensure effective service:

• Ensure adherence to organizational policies, practices, and procedures.
• Identify and recommend areas/ways to improve processes.
• DOFA confirmation from FSB Cardinal system experience will be an advantage.