Claims Specialist: Accident

2 weeks ago

Johannesburg, Gauteng, South Africa Santam Full time
What will you do?

This career opportunity is available at SHA Risk Specialists a division of Santam for a

Claims Specialist:
Accident & Health, who will be based in Johannesburg: Illovo. What will make you successful in this role?

Claims Portfolio
Attend to all aspects related to a portfolio of claims e.g. new claims, current files, diary, mail, recoveries, Agg Tracker management, third party claims, attorney/investigator matters, settlement within mandate etc.
Negotiate settlement agreements within mandate.
Draft settlement agreements.
Strategically manage a portfolio of claims.
Appoint and manage loss adjusters and attorneys where warranted.
Monitor and adhere to service levels in accordance with agreed service level agreements.
Monitor legal loss adjuster fee expenditure and refer concerns to management within the framework of agreed internal protocol.

Analysis
Analyse factual and legal issues when assessing claims.

Critically analyse facts and their impact on the underlying merits assessment as well as the legal aspects of the policy.

Use judgement in making appropriate decisions on merits and policy response.
Critically assess and analyse the information required.
Conduct a strategic assessment of claims and make strategic decisions on handling of claims.
Have an in-depth understanding of technical and legal aspects impacting on the policy's operation.

System processing
Attend to all aspects of system processing relevant to a portfolio of claims e.g. registration of new claims, updating of reserves, cheque requisitions etc.

Client Liaison (Internal and External)

Respond to queries and resolve to the satisfaction of the affected parties within the scope of authority and / or responsibility.

Maintain and adhere to service levels
Prepare for and attend meetings.

General Administration
Produce reports when required.
Attend to daily administrative routine tasks in accordance with organisational standards, processes and procedures.
Attend to the typing of general correspondence if and when necessary. Qualification and Experience

Matric
FAIS compliance (within the required period if not a registered Rep)
Medical Qualification (if possible)
Minimum 6 months A&H claims handling experience a preference
Analysis of medical accounts and medical claims handling a preference
Assessing medical reports and understanding medical terminology Knowledge and Skills

Ability to strategise and drive a claim to finality
Administrative Skills
Analysis and Judgement
Attention to Detail
Client Orientation
Communication Skills including negotiation
Follow Up
Initiative
Interpersonal Skills
Organisational Awareness
Planning and Organising
Teamwork
Computer Literacy
Time management and ability to manage multiple claims at the same time
Attention to detail Core Competencies Being resilient - Contributing dependently Collaborates - Contributing dependently Cultivates innovation - Contributing dependently Customer focus - Contributing dependently Drives results - Contributing dependently About The Company

Santam is the market leader in the general insurance industry in Southern Africa.

We are a large, diversified, expanding and transforming company and whilst based in South Africa, we are rapidly moving into a number of emerging markets, both in Africa and Asia.


Our success is rooted in our passion for our clients and everything we do is centered on our delivery of Insurance Good and Proper.

We're about people.

People drive our business so it follows that we want to recruit the best people possible whether they work for us permanently or for a short time as temporary employees.

At Santam we are committed to transformation and embracing diversity.

This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society.

In achieving our employment equity goals, we give preference to applicants from the designated groups in alignment with the Divisions Employment Equity targets.

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