Claims Specialist: Accident

2 weeks ago

Johannesburg, 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.

  • Marine Claims Specialist

    4 days ago

    Johannesburg, South Africa Energy At Work Full time

    Job Title: Marine Claims SpecialistCompany Overview: Join our client's reputable insurance company, specializing in marine insurance solutions. They are currently seeking a skilled and experienced Marine Claims Specialist to join their Claims Department. Position Overview: As a Marine Claims Specialist, you will play a crucial role in our client's Claims...

  • Marine Claims Specialist

    4 days ago

    Johannesburg, South Africa Energy At Work Full time

    Job Title: Marine Claims Specialist Company Overview: Join our client's reputable insurance company, specializing in marine insurance solutions. They are currently seeking a skilled and experienced Marine Claims Specialist to join their Claims Department. Position Overview: As a Marine Claims Specialist, you will play a crucial role in our client's Claims...

  • Marine Claims Specialist

    3 days ago

    Johannesburg, South Africa Adzuna ZA B C2 Full time

    Job Title: Marine Claims SpecialistCompany Overview: Join our client's reputable insurance company, specializing in marine insurance solutions. They are currently seeking a skilled and experienced Marine Claims Specialist to join their Claims Department. Position Overview: As a Marine Claims Specialist, you will play a crucial role in our client's...

  • Claims Specialist

    4 weeks ago

    Johannesburg, South Africa Jobking Full time

    CLAIMS SPECIALIST: NON-LIFE CLAIMS (LEVEL C1) Munich Reinsurance Company of Africa Limited (MRoA) has been operating in South Africa for 50 years, although the Munich Re (Group) was active on the Continent via Munich Re in Munich for some years prior to commencing the Southern African operation in Johannesburg in 1968. The Head Office of MRoA is in...

  • Non Motor Claims Specialist

    4 weeks ago

    Johannesburg, South Africa Manpower Group SA (Pty) Ltd Full time

    The main purpose of the Claims Specialist’s role is to validate and administrate a client’s claim following a fortuitous event. The claims specialist will be responsible for various Non-Motor Claims. Claims settlement determinations are made in accordance with Standard Operating Procedure, claims guidelines, the specialist own mandate, and the client’s...

  • Claims Specialist

    4 weeks ago

    Johannesburg, Gauteng, South Africa Jobking Full time

    CLAIMS SPECIALIST:NON-LIFE CLAIMS (LEVEL C1)Munich Reinsurance Company of Africa Limited (MRoA) has been operating in South Africa for 50 years, although the Munich Re (Group) was active on the Continent via Munich Re in Munich for some years prior to commencing the Southern African operation in Johannesburg in 1968. The Head Office of MRoA is in...

  • Binder and Outsourced Claims Specialist

    1 month ago

    Johannesburg, South Africa Ultra Personnel Full time

    Matric Certificate and Regulatory Exams Further Education and Training Certificate in Short-Term Insurance NQF 4, and/ or a Higher Certificate in Short term Insurance - NQF 5 Class of Business certification (Personal Lines & Commercial Lines) Highly advantageous Must be compliant with FAIS Fit and Proper requirements with track-record of working...

  • Health Insurance Claims Advisor

    4 weeks ago

    Johannesburg, South Africa LetsLink Recruitment Full time

    Our client is an international insurance company, specialist in international wellbeing offering a variety of international insurance products. They are seeking to employ a Claim Advisor to assist them in the processing of medical claims. **Requirements**: - Matric - FAIS Compliant is preferred. - Minimum 3 to 5 years’ experience. - Customer service...

  • Senior Non-motor Claims Specialist

    1 month ago

    Johannesburg, South Africa Ultra Personnel Full time

    Matric Certificate and Regulatory Exams Further Education and Training Certificate in Short-Term Insurance NQF 4, and / or a Higher Certificate in Short term Insurance - NQF 5 Class of Business certification (Personal Lines & Commercial Lines) Highly advantageous Must be compliant with FAIS Fit and Proper requirements with track-record of working...

  • Claims Specialist: Casualty Claims

    1 month ago

    Johannesburg, South Africa Sanlam Full time

    What will you do? This career opportunity is available at SHA Risk Specialists a division of Santam for a Claims Specialist: Casualty Claims , who will be based in Johannesburg: Illovo. What will make you successful in this role? Claims Practice Management  Attend and manage all aspects related to a portfolio of specialist claims...

  • Claims Assessor Specialist

    4 days ago

    Johannesburg, South Africa FirstRand Full time

    Job Description Dear Future, Claims Assessor Specialist The role requires you to perform accurate assessment, investigation and management of long-term insurance claims in accordance with the goals, objectives, processes and standards of the organization to meet customer expectations. Are you someone who can do the following: - Accurate assessment,...

  • Claims Assessor

    1 month ago

    Johannesburg, South Africa Sanlam Full time

    Who are we? Sanlam Developing Markets [SDM] (a wholly-owned subsidiary of Sanlam Life Limited) is one of the top financial services providers in the South African entry-level and emerging middle market. It aims to understand the unique requirements of clients and offers a wide range of simple and affordable financial solutions that cover needs such as...

  • Claims Assessors

    3 weeks ago

    Johannesburg, South Africa Planet10 Full time

    A leader in the Insurance field is on the look out for Claims Assessors to form part of their Team.  This person will provide specialist advise and support in the generation and provision of reliable claims assessment activities, to support key deliverables and informed decision making, through the execution of predefined objectives as per agreed SOPs....

  • Claims Assessors

    4 weeks ago

    Johannesburg, South Africa Planet10 Full time

    A leader in the Insurance field is on the look out for Claims Assessors to form part of their Team. This person will provide specialist advise and support in the generation and provision of reliable claims assessment activities, to support key deliverables and informed decision making, through the execution of predefined objectives as per agreed...

  • Claims Assessors

    4 weeks ago

    Johannesburg, South Africa Adzuna ZA B C2 Full time

    A leader in the Insurance field is on the look out for Claims Assessors to form part of their Team. This person will provide specialist advise and support in the generation and provision of reliable claims assessment activities, to support key deliverables and informed decision making, through the execution of predefined objectives as per agreed...

  • Claims Consultant

    4 weeks ago

    Johannesburg, South Africa Afrizan People Intelligence Full time

    **JOB DESCRIPTION** **Our client in the Financial Industry is looking for enthusiastic and passionate Claims Consultants, with experience dealing with Home Contents Claims. The purpose of this role would be to provide specialist advise and support ensuring that claims are paid out as accurately and timeously as possible.** **This is a 6-months'...

  • Senior Pi Claims Assessor

    2 weeks ago

    Johannesburg, South Africa PPS Recruitment Full time

    **Job Advert Summary**: This role reports to the Team Manager Claims. Responsible for assessment and management of long-term Sickness, Permanent Incapacity and Disability claims. The role will transfer specialist claims knowledge, in-depth process knowledge and client centric principles. The incumbent will deal with technical and complex claims queries...

  • Commercial Claims Non-Motor

    1 month ago

    Johannesburg, South Africa CFS Recruitment (Pty) Ltd Full time

    My Short Term Insurance Client in Bedfordview is looking for a Non-Motor Claims Specialist.Your main purpose is to validate and administrate a client’s claim following a fortuitous event. You will be responsible for various Non-Motor Claims. Claims settlement determinations are made following Standard Operating Procedure, claims guidelines, the...

  • Operations & Claims Manager

    1 month ago

    Johannesburg, South Africa HR Studio Full time

    **We're looking for** An experienced and highly motivated Operations & Claims Manager who will play a key part in supporting day-to-day operational activities, solving challenging business problems, and managing clients' insurance claims from start to finish. **Who are you?** - You have the ability to manage your own time and responsibilities effectively -...

  • Case / Claim Manager

    4 weeks ago

    Johannesburg, South Africa AS White Global Full time

    **Case Manager / Claim Specialist (based in Australia)** - Our Australia client is looking for Case Manager to be based onsite in New South Wales, Australia. - Working hours: Monday to Friday, normal office hours - Salary: Negotiable - according to Australia pay band - Others: Assistance with visa processing **Job description**: - Provide early, timely and...