Job Description
Main purpose of the Job
Provide exceptional Claims administration for the company's Short-Term Policy holders. To liaise with internal and external parties daily. Responsible for the processing of claims made under the shared policies, including the reporting of claims to the insurance carriers, management and defense of claims and providing for appropriate release upon settlement of claims.
Customer Service
Coordinate insurance process across departments, tracking claims and reporting on aggregate metrics.
Manage the claims intake process for new claims, including gathering information from customers.
Determining whether claims are eligible for coverage under the terms of each insurance policy.
Reviewing records to determine if they support a claim.
Communicating with customers about their claim status, payment amounts, and any other pertinent information.
Daily administration and feedback on claims.
Capture claim details of client and check if premiums have been collected and are up to date.
Check system and determine that clients cover is active before allowing a claim.
Explain claims process and required documentation to clients.
To manage the claim cycle time.
Contact clients and service providers during the claim cycle time.
Identify potential fraudulent claims
To cancel Cover and provide feedback to the SAICB if fraud or misrepresentation was discovered.
To send upliftment request on salvage vehicles
To draft loss agreements and rejection or repudiation letters.
Provide exceptional claim service to clients.
Review claim submissions and determine eligibility and level of coverage.
Prepare and monitor insurance budgets and report on exceptional circumstances.
File claims, enter data, and update databases with current daily information.
Other duties as assigned from time to time
Turn-Around Time
Deliver quality service by providing efficient, quick, and friendly service to clients within agreed SLA.
Respond to clients' issues timeously and swiftly, within escalation parameters to ensure consistency.
Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
Submit all relevant reports as directed, in a timeous manner to the manager
Keep all claims within the required turnaround times.
Ability to work according to strict deadlines and be organised and efficient
Process Adherence
Ability to manage their own workload.
Always comply with company policy and procedures
Pro-active approach to process improvement.
Any additional responsibilities as required from time to time
Work Collaboratively
Build a culture of respect and understanding across the organisation
Recognise outcomes which resulted from effective collaboration between teams
Build cooperation and overcome barriers to information sharing, communication and collaboration across the organization
Facilitate opportunities to engage and collaborate with internal and external stakeholders to develop joint solutions
Self-Management
Follow through to ensure that personal quality and productivity standards are consistently and accurately maintained
Demonstrate consistent application of internal procedures
Plan and prioritise, demonstrating abilities to manage competing demands
Demonstrate abilities to anticipate and manage change
Demonstrate flexibility in balancing achievement of own objectives with abilities to understand and respond to organizational needs
Job Requirements
Minimum Academic, Professional Qualifications & Experience required for this position
Grade 12
Minimum 1 - 2 years experience in a similar role
RE5 (Advantageous)
Behaviors
Energy
Passion
Respect for others
Honest and Fair
Positive Attitude
Client Focus
Tenacity
Achieves Results
Essential
Evaluating Problems
Investigate Issues
Problem Solving
Building Relationships
Communicating Information
Showing Resilience
Adjusting to Change
Giving Support
Processing Details
Structuring Tasks
Prioritise Client Experience
Functional Competencies
PC Literacy- word, excel, email and internet
Ability to communicate effectively and clearly in writing and verbally, including drafting correspondence and documents
Attention to detail and accuracy
Ability to work independently
Function under pressure and ability to work under strict deadlines
Adaptability
The ability to resolve problems and disputes with clients
Client Relationship Management