Job Purpose

• Review and resolve escalated claims outcome and service related disputes in a fair and equitable manner. Contribute to the safeguarding of the organisations reputation by mitigating risk relating to disputes.

Responsibilities

• Solutions Analysis
• Reviewing a claims outcome and customer service complaint. Taking into account policy terms and conditions, ombudsman stances, legislation regulation etc. to determine the correct outcome for the external customers.

Customer Service

• Responsibilities may include processing disputes, dealing with complex queries and investigating and resolving customer disputes and complaints. Act as first line mandated representative providing customer service and handle customer disputes and liaise with the customer/customers attorneys within the given time frames provided by Management. Ensure continuous communication on disputes referred from the applicable platforms, either verbally or by written communication, within the prescribed timelines.

Needs Clarification

• Ask relevant questions to evaluate the customers level of understanding and to identify and respond to areas requiring further information or explanation.

Operational Compliance

• Ensure all work meets operational, technical and financial results and/ or targets as and when required. Deliver on TCF principles in alignment with regulatory requirements. Identify instances of non-compliance with the organisations policies and procedures and/or relevant regulatory requirements, reporting these and escalating issues as appropriate.

Client & Customer Management (Internal)

• Build and maintain relevant relationships with internal departments to assist in managing the customers complaints.

Personal Capability Building

• Develop and maintain excellent procedural or technical skills by keeping up to date knowledge of the Ombudsman and TIH Procedures and philosophies. Develop own capabilities by participating in continuous professional development and coaching; gain or maintain external professional accreditation where relevant to improve performance and fulfill personal potential. Maintain an understanding of relevant legislation, external regulation, and industry best practices through ongoing education.

Education

• Grade 12/ SAQA Accredited Equivalent (Essential); Relevant 3 year Business related degree / diploma (Advantageous); STI Qualification (Advantageous); RE compliant (Advantageous); FAIS compliant (Advantageous)

Experience

• 3 or more years’ experience in an insurance and claims environment (Essential); 1 or more years dispute resolution experience (Essential); Legal background within an insurance industry (Advantageous); Online reputation management experience (Advantageous).