Snr Complex Claims Controller

SUMMARY:
The Complex Claims Controller will ensure effective processing of claims within the governed frameworkto ensure compliance with the short term insurance regulations as well as to assist the Claims Manager with the management of complex claims.

POSITION INFO:

Job summary statement/purpose The Complex Claims Controller will ensure effective processing of claims within the governed framework, to ensure compliance with the short term insurance regulations as well as to assist the Claims Manager with the management of complex claims.

KEY PERFORMANCE AREAS (DUTIES & RESPONSIBILITIES):

1. Claims processes

• Undertake claims processing by receiving registered claims that are within mandate, check & maintain correct reserves and keep a regular follow-up on outstanding documents.
• Approve and settle claims within delegated authority after verification of all documents and validation thereof under the policy cover.
• Assist in the extrapolation of monthly reports on claims.

2. Agency/ broker Liaison

• Inform reinsurers, brokers, underwriting & legal departments and loss adjusters accurately and promptly of large losses.
• Exercise proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim.
• Ensure identification of all claims where appointment of surveyors, adjusters or legal representation or litigation is involved and advise the Claims Manager and relevant Executives.
• Interpret related claims documentation and negotiate settlement and disposition of complex claims.

3. Strategic assistance

• Provide input in the compilation of the departmental annual plan.
• Provide input on the review of the claims processes.
• Review and enhance the claims procedure manual for evaluation by the Claims Manager.
• Continuously review departmental risks.
• Establish gaps between industry developments and Organisation covers.
• Compile Statistical Reports.
• Manage service level agreements with suppliers and ensure deliverables are satisfactory.

4. Perform ad hoc tasks

• Perform any reasonable tasks as and when required by the Line Manager Qualifications:
• Degree / Diploma preferable
• Higher Certificate in Insurance preferable Experience:
• 7 – 10 years’ experience in a Claims position of short-term Insurance company. Knowledge:
• Sound knowledge of claims procedures
• Understanding of claims analysis and settlement
• Understanding relevant legislation
• Understanding of Short Term, commercial and property insurance Technical Skills:

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