Claims Consultant La Lucia

6 days ago


Umhlanga Rocks, South Africa Simply HR Payroll Full time

Claims Fulfilment Consultant A successful and large Homeloan and Insurance company requires the services of a Claims Fulfilment Consultant to join their team. The goal is to consistently exceed and practice customer expectations as governed by regulations on a regular basis and to drive timely settling of claims whilst applying risk management principles at consultant level. Duties & Responsibilities Processing Authorize claims within the set mandate and resolve all claims within the agreed productivity targets and turnaround times by utilizing the claims diary system effectively. Apply and effectively communicate technical skills and resolve all technical issues using available tools and systems. Demonstrate a clear understanding and execution of customer complaints and resolutions that must be maintained and exceeded, as well as a clear understanding of claim rejections. Demonstrate a clear understanding of the management of claims handling that must be followed within the regulated agreements as specified by the relevant regulatory boards. Ensure a clear understanding of all payments, the correct application of rates to be authorized to the service provider, and the correct appointment of service providers to the claims. Demonstrate a thorough understanding of the report and quotes to communicate prompt claims resolution to the customer. Have a clear understanding of how to operate a claims management system, as well as the use of relevant tools that can enable the quick resolution of a claim and ensure effective communication, such as using Outlook to send emails, SMS via grapevine, and exporting own reports to Excel. Have a working knowledge of the internet and how to use Google Maps. Plan, Communicate, Solve Problems, And Carry Out Decisions Effectively. Ensure that all Customers are treated fairly, you must have a clear understanding and accurate interpretation of the reported incident, claims history, and correct application of the policy wording. When communicating technical detail to the Customer, Loss Adjusters to consult or debate the outcome of the claim, ensure lateral thinking and professional engagement with all parties. Have an inquisitive and investigative mind to communicate and report suspicious activity to the next reporting level if further intervention is required. Possess the ability to communicate calmly and professionally yet assertively with difficult customers at all levels and outcomes in a fair, sensitive, and persuasive manner, always keeping in mind that the customer must be treated fairly as required. Have a clear understanding of how to engage and communicate with the appropriate specialist service providers to engage on each claim, such as engineers, etc. Practice and Promote Consistent Effective Relationship Building Maintain effective relations with all stakeholders within the organization. This includes but is not limited to: Internal Finance Division to improve on service delivery issues regarding



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