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Claims Consultant

3 months ago

Johannesburg, Saudi Arabia PPS Full time

Job Advert Summary
Co-ordinate and oversee, manage negotiate and settle personal lines and commercial claims and account for the finalisation of the claim end-to-end. Delegate authority to manage the process and resolve any conflict by a negotiating, settlement, and finalisation functionality. Administer and validate claims correctly and efficiently within the specifications of PPS Short-Term Insurance Company's policy terms and conditions. 

Minimum Requirements
Education:

  • NQF Level 4: Grade 12
  • Certificate of Proficiency in related field

 Experience:

  • 5+ years experience in a Short-Term Insurance Claims environment
  • Short-term Insurance Industry experience will be advantageous.
  • Codeplex experience would be an advantage.

Knowledge and Skills:

  • Strong communication skills written & verbal.
  • Strong customer service skills.
  • Service driven, with a focus on accuracy and quality of information delivered within service levels.
  • Strong attention to detail.
  • A strong work ethic and a drive to exceed expectations.
  • Strong analytic and problem-solving skills.
  • Adaptability to different stakeholders, audiences, and environments.

Competencies:

  • Adapting and responding to change.
  • Persuading and influencing.
  • Deciding and Initiating Action.
  • Coping with pressure.

Duties and Responsibilities

Validation of Insurance Claims

  • Validate claims in a friendly, courteous, and professional manner to all stakeholders within the prescribed turnaround times as documented and agreed in various service level agreements
  • Accurately document all interactions, decisions, and transactions related to the claims process. This includes maintaining detailed records of claim documents, correspondence, and any investigation findings
  • Investigate the merits of a specific claim and determine if the services of an assessor / loss adjustor would be required and appoint the most appropriate preferred assessor / loss adjustor where necessary to perform further investigations
  • Verify that all requirements are met e.g. alarm systems, etc in terms of the policy contract
  • Confirmation of conflicting statements with relevant parties
  • Make decision within financial mandate and within the set-out processes

Process optimization and efficiencies 

  • Duties include working with cross-functional teams to deliver exceptional service to all intermediaries/members as set out in the relevant service level agreements
  • Combat insurance fraud by ensuring strict compliance to mandates, set procedures, philosophies and Company rules and regulations
  • Identify opportunities for process improvements and efficiency enhancements within the claims handling department. Offer feedback and suggestions to enhance customer experience and streamline operations
  • Uphold all service excellence principals as communicated by management

Stakeholder Management

  • Build and maintain relationships with internal and external stakeholders
  • Collaborate effectively with peers to achieve business results