Job Summary
An exciting opportunity is available with one of our Clients for a Commercial Claims Handler to join their Claims
Department.
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 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 thepercentage of cash versus quantum.
Qualifications:
- 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:
- 5+ years’ experience: Commercial lines claims experience across all commercial sections of the
policy. 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)
- Knowledge of Heavy Haulage Vehicles, Business Interruption, Personal Accident and stated benefits,
Machinery Breakdown, Fidelity, SASRIA and Hospitality and Leisure risks a recommendation.
- Experience in the short-term insurance industry
