Claims Specialist

2 weeks ago


Sandton, South Africa Santam Insurance Full time

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We have an exciting opportunity for the Claims Specialist within SHA Risk Specialists.

What will make you successful in this role?

Key responsibilities:

  • Attend and manage all aspects related to a portfolio of specialist claims such as claims registration, case management, drafting, diary, recoveries, and settlement negotiations.
  • Draft settlement agreements and other legal documents within mandate as per the Claims Governance Folder.
  • Strategically manage a portfolio of claims.
  • Manage loss adjusters and attorneys appointment on matters and ensure compliance with agreed service level agreements.
  • Monitor and manage legal spend of attorneys and loss adjusters.
  • Manage system processing and compliance with systems by way of payments, updating signed off reserves, proper recordal of information etc.
  • Attend to Operational duties as allocated.
  • Compile and manage risk reports when required.
  • Actively manage and record claims above certain thresholds as per The Claims Governance Folder and report on matters to Claims Co and Executive where required.
  • Comply with internal and external regulatory framework and internal and external processes and procedures in accordance with organisational standards.
  • Draft processes and procedures that are compliant with relevant regulatory framework and applicable legislation.
  • Effectively liaise and interact with Underwriters.

Analysis:

  • Consider, analyse and interpret insurance policy and the contractual impact thereof for the determination of coverage;
  • Critically analyse the facts of the matter and their impact on the underlying policy.
  • Draft opinions on the interpretation of coverage in relation to the facts and the applicable policy, present and motivate;
  • Draft opinions on merits and quantum of matter with the relevant caselaw and legislation applicable;
  • Apply critical thinking to ensure appropriate decisions on merits, quantum and policy response.
  • Critically consider and evaluate information provided and identify information required.
  • Conduct a strategic assessment of claims and make strategic decisions and recommendations on handling of claims.
  • Develop and maintain an understanding of technical and legal aspects impacting on the policy's operation.
  • Make representations and recommendations on improved wording and trends identification to underwriters.
  • Be involved in continuous training and development in respect of Case Law, Policy wording, etc.
  • Assist in identifying and developing SOP's and processes to ensure claims department effectiveness.
  • Take initiative in creating opportunities of interaction with Brokers and Insureds.

Client Liaison (Internal and External):

  • Liaise with clients to resolve queries to the satisfaction of the affected parties within the scope of authority and / or responsibility.
  • Prepare for and attend meetings and consultation with brokers, insureds, legal representatives and loss adjusters.
Skills and Competencies
  • 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
  • Ability to strategise and drive a claim to finality
Qualifications & Experience
  • Matric
  • Law Degree
  • Admitted attorney
  • FAIS compliance a preference
  • Previous non-motor liability claims handling experience
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