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Claims Controller
2 weeks ago
- 2024/05/2 Reference Number
- SAS
- Job Title
Claims Controller
- C
- Job Type
- Permanent
- Division
- Insurance Operations
- Department
- C
- EE Occupational Levels
- Level 4 & 5: Skilled, Technical and Academically Qualified
Location
- Town / City
- Johannesburg
Location
- Province
- Gauteng
Location
- C
- South Africa
- Job Advert Summary
- To ensure compliance with the shortterm insurance regulations, ensure effective processing of claims
- Minimum Requirements
Qualifications:
Relevant Diploma/ Higher Certificate in Insurance preferable
Tertiary qualification preferable (NQF Level 6)
Experience:
- 6 years' experience in a Claims handling position within short-term (non-life) Insurance Industry
Responsibilities:
Claims Processes
- Deal with technically complex claims within their mandate.
- Verify and validate all documents under the policy cover and approve or reject claims within delegated authority.
- Exercise proper judgment and decisionmaking to analyse the claimed exposure, determine the
- Assist Junior Claims Controllers on technical claims.
- Ensure workflow is managed properly on CMS system.
- Daily (or as required by management) progress reporting.
Stakeholder Management (Agency/Broker & Service Provider Liaison)
- Engage with brokers and Agent companies promptly as required.
- Engage with Underwriting department on cover issues, inform them of gaps in cover and policy
required or involved and advise the Line Manager, Claims Manager and relevant Executives.- Identify and discuss with Line manager appointment of service providers in line with DOA
(Delegation of Authority).- Engage any other department or stakeholder as required for the achievement of divisional goals.
- Manage service level agreements with suppliers and ensure deliverables are satisfactory.
Claims Operations
- Provide input into the improvement of claims processes and procedures in line with best practices.
- Ensure compliance and risk management policies are adhered to in daytoday claims activities.
- Assist line management in compiling claims performance statistics.
- Provide input into potential improvement of policy wording and agent procedure manuals based on
Ad hoc Tasks
Perform any reasonable tasks as and when required by the Line Manager.
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