CLAIMS HANDLER

SUMMARY:
The Claims Handler is accountable for the claim during the entire life cycle (end-to-end).

POSITION INFO:

Your verbal and written communication, in English and Afrikaans, at all levels as well as:

Formal Education:

• Matric
• Relevant NQF 5
• Successfully completed the RE 5 Examination Level 1

Experience:

• A minimum of three (3) years´ Claims experience
• A minimum of five (5) years´ working experience within Insurance industry

will enable you to do the following duties:

Effectively maintain claims standards and provide quality client service:

• Register motor / non motor claims for personal and commercial policies
• Appoint assessors
• Confirm and make sure that cover is sufficient
• Responsible for handling of and settling of claims for clients allocated and ensuring accurate capturing and updating on all data systems
• Manage the claim from start through to settlement stage
• Gathering information about the insurance claim from the client and any others involved
• Examining the details on completed forms and checking these against the cover provided by the insurance policy
• Consulting with other staff to decide the outcome of the claim and any compensation to be paid
• Informing the client of the outcome of the claim in writing
• Referring 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
• Do continuous adjustments of reserves
• Arrange / deal with the fulfilment of the following:
  • Car hire for insured in the event of an accident where vehicle not drivable or of car has been stolen
• Arrange contractors to assist insured with obtaining critical documents to support claim
• Manage salvage process
• 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 Insurance market
• Keep detailed, dated file notes of all discussions on the claim files
• Ability to negotiate contentious claim with Insurance market and clients
• Potential errors and omissions must be immediately referred to Claims Manager
• Responsible for completion of claim files upon finalisation of claim and do filing to EDS
• Ensure that claims files are maintained in accordance with operational standard 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
• To 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.

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.

Maintain effective people practices:

• 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.