Job Description

To provide a quality Specialist claims service, ensure containment of claims spend and provide excellent service in setting a culture of best practice within mandated responsibility.

Competencies

Critical objectives and responsibilities

• Strategic thinking
• Customer centracity
• Collaboration
• Leading with Influence
• Innovation
• Personal Mastery
• Executing

Key Responsibilities

• End-to-end claim processing including negotiation and settlement of Speciality Lines of Business  claims
• Process Speciality lines claims in adherence with SLA.
• Arrange assessment in adherence with SLA.
• Review merit of claim.
• Complete Risk assessment and additional support request analysis.
• Clarify and amend information where required
• Appoint the support service required.
• Review Support Function Report.
• Calculate and Analyse technical computations.
• Capture all relevant claims updates and decisions on system.
• Manage Diarised actions aligned to SOP
• Prepare Rejection Letter , where required.
• Prepare Payment with communication details.
• Await additional information on multiple payments, if required.
• Continuously improve claims service, manage claims spend and contain the increase in average cost of claims.
• Improve / maintain Speciality Lines  Claims service effectively.
• Reduce/ maintain turnaround time of Speciality Lines Claims.
• Ensure effective implementation and compliance of claims/ operational systems or procedures.
• Ensure diary is maintained.
• Ensure estimates are raised accurately and timeously in accordance with best practice as and when new claims and new documents are actioned.
• Adhere to Speciality Claims Standard Operations Procedures
• Maintain Turn Around Times

Experience, knowledge & skills required

• Matric
• Appropriate insurance qualification background
• Knowledge and interpretation of Speciality Lines  policies
• 2 years Speciality Lines  claims handling
• 4 years Commercial Non motor experience