Job Purpose

• Deliver and support sound quality of claims decision making, prevent fraud and manage expenditure through the validation of claims by using expert abilities in various fields of investigation.

Responsibilities

Needs Assessment

• Explore issues or needs, establishing potential causes and barriers as well as related issues. Validate claims by investigating, applying expertise, utilising resources e.g. police, supplier etc. and interviewing customers as well as other parties.
• Analyse specific problems and issues to
• find the best solutions. Solutions could be technical or professional in nature.

Data Collection & Analysis

• Ask questions, collect data from a variety of sources, analyse information and investigate claim. Ensure effective costing of claimed items through ensuring professional, thorough investigation of claims. 
• Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools ITC, supplier contract and/or negotiation to accurately cost applicable claims on a day to day basis.

Customer Service

• Provide a quality service to customers while identifying opportunities to secure new business or support retention. Responsibilities may include processing cases, dealing with complex queries and investigating and resolving customer problems.
• Uphold agreed service level agreements set turnaround times and ensuring customer satisfaction and retention.

Stakeholder Engagement

• Effectively build, maintain and manage relationships with service providers and suppliers, colleagues, internal and external customers.

Work Scheduling and Operational Compliance

• Contribute to optimize work practices and procedures by maintaining an acceptable workload in order to get the job done, coordinating with support services. 
• Ensure claims are finalised within the set parameters turnaround time, terms
• and conditions applied accurately.

Administration

• Produce, update and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.
• Ensure accurate administration and underwriting of claims.
• Maintain an acceptable claims expenditure
• ratio by finalising and adjusting claims accurately.

Compliance

• Identify shortcomings in compliance processes, systems and procedures, and develop ad hoc solutions to problems within an assigned unit or discipline.

Up-Sell Customer Propositions

• Identify a selection of products or services that may meet the customer's requirements, explain the product/service features influence the customer to add additional cover.

Personal Capability Building

• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.
• Remain up to date with current and new quality standards and product knowledge to enable effective decision making.

Education

• Grade 12/ SAQA Accredited Equivalent Essential; Regulatory Examination Essential; Science Mechanical / Physical, Mathematics and African Language Advantageous; Forensic Investigation Diploma / Insurance Institute qualification Advantageous