Personal Lines Claims Handler

6 days ago

Centurion, South Africa The Talent Hive Full time

Capturing of all new claim where applicable.
- One point of contact for the client/broker and adherence to first call resolution.
- Deliver exceptional client service that exceeds customers’ expectations through proactive, innovative and appropriate claims handling.
- Ensures that customer claim is handled efficiently.
- Verifies FNOL data or documentation provided to ensure correct settlements of claim
- Attend to validation and first call actions on all claims within 1 working hour after registration.
- Achieve minimum targets were applicable.
- Maintain appropriate diaries and messages on the operating system.
- Client input and communication is an integral part at the start of the entire claims value chain, ensuring that complete and accurate data/documentation is obtained and captured. This determines the direction of the claim to the entire claims value chain.
- Effectively maintains oversight of all relevant claims tasks and manages the claims handling process to achieve timely settlement and to minimise inaccuracies
- Identify, investigate and resolve any issues relating to claims being handled in line with claims policies and procedures such as SLAs and TAT.
- Accurately check/determine whether appropriate cover is in place, interpret policy wordings and conditions to determine the validity of claims and advises the broker/policyholder accordingly.
- Identify potential non-disclosure and misrepresentation cases and follow Insurer's procedures to deal with these situations.
- Identify any red flags on claims which are potentially fraudulent and follow Insurer procedures for dealing with these.
- Identify when a specialist is needed to investigate a claim and follow Insurers policies and procedures for appointing these.
- Identify possible recovery and third-party claims and link the claim to the legal department upon registration.
- Negotiates effectively within agreed mandate limits using an appropriate negotiation style.
- Adhere to client' s guidelines for referral of claims to management (e.g. large losses)
- Selects and appoints external experts/vendors following Insurer's procedures and authority levels.
- Utilises preferred service suppliers when dispatching service to clients in line with BBEEE targets e.g. Spend direction tools.
- Matric is an essential requirement
- FAIS Credits (150+)
- Must be Fit & Proper in terms of the FAIS Act
- Regulatory Exam: Representatives
- Must not be debarred with FSB

Work Experience
- 2 - 5 years’ experience: Personal lines claims experience with all types of Motor and Non-Motor claims. Commercial experience will be an advantage.
- Full function claims administration (registration of claim, appoint assessors, read assessors report, make decision on claim up to payment of claim)
- Experience in the financial services industry or short-term insurance industry

**Minimum Requirements**:

- PC literate - Microsoft Office products skills (Outlook, Word, Excel)
- Good typing skills (accuracy & speed)
- Sound knowledge of Insurance principles
- Websure system experience will be an advantage, but not a require

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