Job Title : Quality Assurance Officer

Job Responsibilities:

1. Validation of claims in line with Company guidelines and Standard Operating Procedures.
2. Management of large loss and complex claims.
3. Appointment of necessary providers.
4. Authorization and settlement of claims.
5. Rejection of claims when necessary.
6. Processing payments within the designated turn-around time.
7. Providing payment confirmations to Brokers and Suppliers.
8. Assisting clients and brokers via phone and email with claims and queries.
9. Managing relationships with allocated brokers, including training on binder and outsource arrangements.

Agreements:

1. Oversight and management of binder and outsource brokers.
2. Handling and resolving complaints.
3. Liaising with Service Providers.
4. Liaising with brokers and clients.

Requirements:

1. Regulatory Exam.
2. Further Education and Training Certificate in Short-Term Insurance – NQF 4, and/or a Higher Certificate in Short-Term Insurance.
3. Class of Business certification (Personal Lines & Commercial Lines) – Highly advantageous.
4. Must be compliant with FAIS Fit and Proper requirements and have a track record of working independently.
5. Knowledge of Marine and Engineering insurance – Highly advantageous.
6. Proficiency in Microsoft Word, Excel, and Outlook.
7. Experience in Commercial and Personal lines insurance.
8. At least 5-10 years of relevant experience in claims validation and settlement, including Motor and Non-Motor claims, in both Personal and Commercial Lines.
9. Experience within a licensed insurer or Underwriting Manager.
10. Experience making claims settlement determinations with mandates exceeding R250 000.00.
11. Strong technical understanding of relevant short-term insurance policy wording.