Claims Handler - South Africa
Duties and Responsibilities: • Capturing of all new claim where applicable. • One point of contact for the client/broker and adherence to first call resolution. • Deliver exceptional client service that exceeds customers’ expectations through proactive, innovative and appropriate claims handling. • Ensures that customer claim is handled efficiently. • Verifies FNOL data or documentation provided to ensure correct settlements of claim • Attend to validation and first call actions on all claims within 1 working hour after registration. • Achieve minimum targets were applicable. • Maintain appropriate diaries and messages on the operating system. • Client input and communication is an integral part at the start of the entire claims value chain, ensuring that complete and accurate data/documentation is obtained and captured. This determines the direction of the claim to the entire claims value chain. • Effectively maintains oversight of all relevant claims tasks and manages the claims handling process to achieve timely settlement and to minimise inaccuracies • Identify, investigate and resolve any issues relating to claims being handled in line with claims policies and procedures such as SLAs and TAT. • Accurately check/determine whether appropriate cover is in place, interpret policy wordings and conditions to determine the validity of claims and advises the broker/policyholder accordingly. • Identify potential non-disclosure and misrepresentation cases and follow Insurer's procedures to deal with these situations. • Identify any red flags on claims which are potentially fraudulent and follow Insurer procedures for dealing with these. • Identify when a specialist is needed to investigate a claim and follow Insurers policies and procedures for appointing these. • Identify possible recovery and third-party claims and link the claim to the legal department upon registration. • Negotiates effectively within agreed mandate limits using an appropriate negotiation style. • Be familiar with the Insurers estimate philosophy and apply accordingly. • Adhere to Brolink' s guidelines for referral of claims to management (e.g., large losses) • Selects and appoints external experts/vendors following Insurer's procedures and authority levels. • Utilises preferred service suppliers when dispatching service to clients in line with BBEEE targets e.g., Spend direction tools. • Assist with emergencies and afterhours process for outsourced business. • Minimizes cash settlements vs utilization of preferred suppliers for settlement by managing the percentage of cash versus quantum. • Demonstrates an effective communication style, that motivates, across internal and external teams and individuals that may become involved with claim tasks. • Salvage collection and management of timelines on salvage claims • Meeting of set deadlines. • Validate claims accordingly within the department structure. • Deliver strategic results in term of the Brolink Vision and Mission. • Attendance of weekly team meetings, participation on one-on-one discussion and other meetings required from time to time • Align own behaviour with the organisation culture and values. • Demonstrate commitment toward the team and participate in building team culture. • Collaborate and work closely with all role players thereby leveraging constructive team dynamics and innovation • Identify and recommend areas/ways to improve processes. • Proactively ensure the most effective use of time, resources, money, materials or equipment in line with policies and procedures. • Comply with corporate governance policies, procedures and standards. • Proactively suggest improvements in customer services where applicable. • Building relationships with all stakeholders, including brokers and service providers, to best support the company shared goal to achieve profit. • Manage own development to increase own competencies. • Adhere to the company policies and procedures and contracted performance agreement. QUALIFICATIONS AND EXPERIENCE Minimum Requirements: • Matric is an essential requirement • FAIS Credits (as per FAIS requirement) • Must be Fit & Proper in terms of the FAIS Act • Regulatory Exam: Representatives • Must not be debarred with FSB Work Experience Minimum Requirements:• 2 – 5 years’ experience: Personal lines claims experience with all types of Motor and NonMotor claims. Commercial experience will be an advantage. • Full function claims administration (registration of claim, appoint assessors, read assessors report, make decision on claim up to payment of claim) • Experience in the financial services industry or short-term insurance industry
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