Senior Claims Negotiator & Settlements Specialist

PPS; Johannesburg; Sur place; ZAR 180 000 - 300 000; Plein temps

Résumé du poste

PPS Short-Term Insurance is seeking a claims professional to coordinate and oversee personal and commercial claims end-to-end. You will delegate authority, resolve conflicts, and ensure accuracy and efficiency in line with PPS policy terms.

The role requires strong communication, detailed record-keeping, and negotiation skills to assess merits, appoint assessors, and support service levels across stakeholders.

Qualifications

• Strong communication skills (written & verbal).
• Strong customer service skills.
• Service driven, with a focus on accuracy and quality of information delivered within service levels.
• Strong attention to detail.
• A strong work ethic and a drive to exceed expectations.
• Strong analytic and problem-solving skills.
• Adaptability to different stakeholders, audiences, and environments.

Responsabilités

• Validate claims in a friendly, courteous, and professional manner to all stakeholders within the prescribed turnaround times as documented and agreed in various service level agreements.
• Accurately document all interactions, decisions, and transactions related to the claims process. This includes maintaining detailed records of claim documents, correspondence, and any investigation findings.
• Investigate the merits of a specific claim and determine if the services of an assessor / loss adjustor would be required and appoint the most appropriate preferred assessor / loss adjustor where necessary to perform further investigations.
• Verify that all requirements are met (e.g. alarm systems, etc) in terms of the policy contract.
• Confirmation of conflicting statements with relevant parties.
• Make decision within financial mandate and within the set-out processes.
• Duties include working with cross-functional teams to deliver exceptional service to all intermediaries/members as set out in the relevant service level agreements.
• Combat insurance fraud by ensuring strict compliance to mandates, set procedures, philosophies and Company rules and regulations.
• Identify opportunities for process improvements and efficiency enhancements within the claims handling department. Offer feedback and suggestions to enhance customer experience and streamline operations.
• Uphold all service excellence principals as communicated by management.
• Build and maintain relationships with internal and external stakeholders.
• Collaborate effectively with peers to achieve business results.

Connaissances

Claims handling

Customer service

Attention to detail

Communication

Problem solving

Adaptability

Formation

NQF Level 4

Grade 12

Certificate of Proficiency

Description du poste

PPS Short-Term Insurance is seeking a claims professional to coordinate and oversee personal and commercial claims end-to-end. You will delegate authority, resolve conflicts, and ensure accuracy and efficiency in line with PPS policy terms.

The role requires strong communication, detailed record-keeping, and negotiation skills to assess merits, appoint assessors, and support service levels across stakeholders.