Claims Handler (X4)

Energy at Work Projects; Johannesburg; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A leading claims management company in Johannesburg is seeking a Claims Handler to manage claims efficiently and provide exceptional client service. The ideal candidate will have at least a Matric qualification, FAIS Credits, and 2–5 years of experience in personal lines claims. Responsibilities include capturing claims, ensuring adherence to policies, and negotiating settlements.

Qualifications

• Matric is essential.
• FAIS Credits required.
• 2–5 years’ experience in claims handling.

Responsibilities

• Capture all new claims in a timely manner.
• Deliver exceptional client service.
• Ensure claims are handled efficiently.

Skills

Client service excellence

Claims handling

Negotiation skills

Problem-solving

Education

Matric

FAIS Credits

Fit & Proper as per FAIS Act

Job description

Duties and Responsibilities :

• Capture all new claims where applicable.
• Serve as the point of contact for clients/brokers, ensuring adherence to first call resolution.
• Deliver exceptional client service that exceeds expectations through proactive, innovative, and appropriate claims handling.
• Ensure claims are handled efficiently.
• Verify FNOL data and documentation to ensure correct claim settlements.
• Attend to validation and first call actions on all claims within 1 working hour after registration.
• Achieve minimum targets where applicable.
• Maintain diaries and messages on the operating system appropriately.
• Ensure complete and accurate data/documentation is obtained at the start of the claims process, guiding the claim through the entire value chain.
• Oversee claims tasks to achieve timely settlement and minimize inaccuracies.
• Identify, investigate, and resolve issues related to claims in line with policies, SLAs, and TATs.
• Determine coverage and interpret policy wordings to validate claims, advising brokers/policyholders accordingly.
• Identify potential non-disclosure, misrepresentation, and fraud cases, following insurer procedures.
• Recognize when specialist investigation is needed and follow procedures for appointment.
• Identify possible recovery and third-party claims, linking them to legal departments upon registration.
• Negotiate within mandate limits using appropriate styles.
• Be familiar with the insurer's estimate philosophy and apply it.
• Follow guidelines for claims referral to management (e.g., large losses).
• Appoint external experts/vendors following procedures and authority levels.
• Use preferred service providers in line with BBEEE targets.
• Assist with emergency and after-hours processes for outsourced business.
• Manage cash settlements versus preferred suppliers to optimize costs.
• Communicate effectively with internal and external teams involved in claims.
• Manage salvage collection and timelines.
• Meet deadlines and validate claims within the department.
• Align with the company's vision and mission.
• Participate in team meetings, one-on-one discussions, and other required meetings.
• Align behavior with organizational culture and values.
• Participate in team building and demonstrate commitment.
• Collaborate with all role players to leverage team dynamics and innovation.
• Identify and recommend process improvements.
• Use resources effectively in line with policies and procedures.
• Comply with governance policies, procedures, and standards.
• Suggest improvements in customer service where applicable.
• Build relationships with stakeholders, including brokers and service providers, to support profit goals.
• Manage personal development to enhance competencies.
• Adhere to company policies, procedures, and performance agreements.

Qualifications and Experience

Minimum Requirements :

• Matric is essential.
• FAIS Credits (per FAIS requirements).
• Fit & Proper in terms of the FAIS Act.
• Regulatory Exam: Representatives.
• Must not be debarred by the FSB.

Work Experience :

• 2–5 years’ experience in personal lines claims, handling Motor and Non-Motor claims; commercial experience is an advantage.
• Full claims administration experience, including registration, assessing, decision-making, and payment.
• Experience in the financial services or short-term insurance industry.