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.
, Requirements,
Education
- NQF Level 4: Grade 12
- Certificate of Proficiency in related field
- 5+ years experience in a Short-Term Insurance Claims environment
- Short-term Insurance Industry experience will be advantageous.
- Codeplex experience would be an advantage.
- 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.
- Adapting and responding to change.
- Persuading and influencing.
- Deciding and Initiating Action.
- Coping with pressure.
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
- 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
- Build and maintain relationships with internal and external stakeholders
- Collaborate effectively with peers to achieve business results
