SUMMARY:
The role encompasses the management, assessment, and resolution of insurance claims.
POSITION INFO:
Our client requires a Claims Handler. Your:
Formal Education:
- Matric
- RE 5 Examination Level 1
- Class of Business: Commercial and Personal Lines
- NQF 5 in short term insurance
Experience:
- At least 5 years short term experience and 4 within the claims environment.
will enable you to do the following duties:
Claims Registration and Acknowledgement:
- Receive, review, and register new claims via phone, email, or digital channels.
- Acknowledge receipt of claims to clients within stipulated turnaround times.
Initial Assessment and Documentation:
- Collect all necessary documentation from clients to substantiate claims (e.g., claim forms, supporting evidence, police reports, photographs, invoices).
- Assess policy coverage, terms, and conditions for each claim.
- Request additional information from clients or third parties when required.
Investigation and Evaluation:
- Conduct investigations through interviews, site visits, and consultation with service providers or loss adjusters.
- Verify the legitimacy and validity of claims.
- Apply technical knowledge to interpret policy wordings and determine liability.
Claims Processing and Settlement:
- Calculate and agree settlement amounts in line with policy terms, ensuring fairness and compliance.
- Negotiate settlements with clients, service providers, and, where necessary, legal representatives.
- Authorise and process payments within designated authority limits.
Customer Service and Communication:
- Maintain regular communication with clients throughout the claims process, providing updates and managing expectations.
- Respond to queries, complaints, and escalations in a timely and professional manner.
- Deliver empathetic service during potentially stressful situations for clients.
Fraud Detection and Prevention:
- Identify potential fraudulent activity and escalate cases in line with company procedures.
- Work closely with internal audit and fraud prevention teams as required.
Reporting and Documentation:
- Maintain accurate records and documentation for all claims handled.
- Prepare and submit reports for management, compliance, and regulatory purposes.
Continuous Improvement and Compliance:
- Stay informed of changes to insurance legislation, industry trends, and best practices.
- Participate in training and development opportunities to enhance skills and knowledge.
- Adhere to company policies, procedures, and ethical standards at all times.
