Claims Handler (X4)

Energy at Work Projects; Johannesburg; On-site; ZAR 250 000 - 350 000; Full time

Job summary

A leading company in the financial services sector is seeking a Claims Handler to manage client claims effectively. The role involves capturing claims, ensuring first call resolution, and delivering exceptional service through proactive claims handling. Candidates should have 2-5 years of relevant experience and necessary qualifications including Matric and FAIS credits.

Qualifications

• 2-5 years’ personal lines claims experience.
• Full claims administration experience from registration to payment.
• Experience in financial services or short-term insurance.

Responsibilities

• Capture new claims and ensure first call resolution.
• Verify FNOL data for correct claim settlements.
• Engage clients early in the claims process.

Skills

Client Service

Claims Handling

Negotiation

Problem Solving

Education

Matric certification

FAIS Credits

Regulatory Exam: Representatives

Job description

Job Responsibilities

1. Capture all applicable new claims.
2. Serve as the single point of contact for clients/brokers, ensuring first call resolution.
3. Deliver exceptional client service through proactive, innovative, and appropriate claims handling.
4. Ensure efficient handling of customer claims.
5. Verify FNOL data or documentation to ensure correct claim settlements.
6. Attend to validation and first call actions on all claims within 1 working hour after registration.
7. Achieve minimum targets where applicable.
8. Maintain diaries and messages on the operating system.
9. Engage clients early in the claims process, ensuring complete and accurate data collection to guide the claim's trajectory.
10. Oversee all relevant claims tasks to achieve timely settlement and minimize inaccuracies.
11. Identify, investigate, and resolve issues related to claims in line with policies, SLAs, and TATs.
12. Check and interpret policy cover, wording, and conditions to validate claims and advise accordingly.
13. Identify potential non-disclosure, misrepresentation, and fraud cases, following insurer procedures.
14. Determine when specialist investigation is needed and follow policies for appointment.
15. Identify recovery and third-party claims, linking them to legal departments upon registration.
16. Negotiate within mandate limits, applying appropriate negotiation styles.
17. Use insurer estimate philosophies and adhere to guidelines for claims referral.
18. Appoint external experts/vendors following procedures and authority levels.
19. Utilize preferred service suppliers in line with BBEEE targets.
20. Assist with emergency and after-hours processes for outsourced business.
21. Manage cash settlements versus utilization of preferred suppliers to optimize costs.
22. Communicate effectively across teams and stakeholders involved in claims.
23. Manage salvage claims and timelines efficiently.
24. Meet set deadlines and validate claims within the department.
25. Contribute to strategic goals aligned with the company's vision and mission.
26. Participate in team meetings and individual discussions, demonstrating organizational commitment.
27. Build relationships with stakeholders, including brokers and service providers, to support company goals.
28. Identify and suggest process improvements proactively.
29. Ensure optimal use of resources, materials, and equipment according to policies.
30. Comply with corporate governance policies and standards.
31. Suggest customer service improvements where applicable.
32. Manage personal development to enhance competencies.
33. Adhere to company policies, procedures, and performance agreements.

Qualifications and Experience

Minimum Requirements:

• Matric certification.
• FAIS Credits (per FAIS requirements).
• Fit & Proper status under the FAIS Act.
• Regulatory Exam: Representatives.
• Not debarred by FSB.

Work Experience:

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