CLAIMS HANDLER I

HR Options; Randburg; On-site; ZAR 300 000 - 600 000; Full time

Job summary

An established industry player is seeking a dedicated Claims Specialist to enhance their claims processing team. This role involves managing claims from start to finish, ensuring a seamless experience for clients while upholding the highest standards of service. You will be responsible for negotiating claims, maintaining accurate records, and providing exceptional customer service. The ideal candidate will have a strong background in the Short Term Insurance industry and a passion for delivering quality results. Join a company committed to continuous improvement and customer satisfaction, where your expertise will make a significant impact.

Qualifications

• Minimum of 5 years in Short Term Insurance and 2 years in Claims.
• Experience in handling and settling claims effectively.

Responsibilities

• Manage claims from registration to settlement, ensuring quality service.
• Negotiate claims with clients and service providers.

Skills

Claims Management

Customer Service

Negotiation Skills

Attention to Detail

Problem Solving

Education

Relevant Insurance Qualification

Tools

Cardinal 360

Job description

Experience:

• A minimum of two (2) years Claims experience with a claims settling mandate
• A minimum of five (5) years working experience within the Short Term Insurance industry

Processes:

• Effectively maintain claims standards and provide quality client service
• Register motor/non-motor claims for personal and commercial policies
• Appoint assessors
• Confirm and ensure that cover is sufficient
• Responsible for handling and settling claims for allocated clients, 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 any 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
• Perform 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 if the car has been stolen
• Arrange contractors to assist the insured with obtaining critical documents to support the claim
• 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 the Claims Manager
• Responsible for completion of claim files upon finalization of claims and do filing to EDS
• Ensure that claims files are maintained in accordance with operational standards 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 in order 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

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
• 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 360 system experience will be an advantage.