CLAIMS HANDLER II

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

POSITION INFO:

Your:

Formal Education:

• Matric
• Relevant NQF 5
• Successfully completed the RE 5 Examination Level 1
• Commercial and Personal Lines Class of Business

Experience:

• A minimum of three (3) years Claims experience with a claims settling mandate
• A minimum of five (5) years working experience within the Short Term Insurance industry

will enable you to do the following duties:

Processes:

• 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.

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.
• 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.

Technology:

• 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.