Claims Examiner-liability

2 weeks ago

Cape Town, South Africa Sedgwick Full time

Claims Examiner-Liability

IF YOU CARE, THERE’S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick’s talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets—their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
With one of the largest teams of liability experts in the world, Sedgwick supports and resolves property, general, auto, product and professional liability claims. We help our clients maintain brand protection in times of crisis.
- PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- QUALIFICATION
- Education & Licensing
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
- Experience
Five (5) years of claims management experience or equivalent combination of education and experience required.
- Skills & Knowledge
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service Expectations
- WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
- Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
- Physical: Computer keyboarding, travel as required
- Auditory/Visual: Hearing, vision and talking
- NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
- The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variance

  • Claims Administrator

    7 days ago

    Cape Town, South Africa City of Cape Town Full time

    ELIGIBILITY CLOSING DATE 28.04.2023 REFERENCE NUMBER FIN 24/23 Ext SALARY **Basic Salary**: R 453 794 p.a DEPARTMENT Treasury Services DIRECTORATE FINANCE Claims Administrator - Public Liability **Requirements**: - A relevant Law diploma or degree with knowledge in the field of Law of Delict. - ACII / AIISA / FCII / FIISA membership would be...

  • Claims Assessor

    3 weeks ago

    Cape Town, South Africa Old Mutual Full time

    Description This role uses specialist technical knowledge to assess risk for the business and/or specific products.  This role is for a dynamic individual with a willingness to learn and be part of a specialised claims assessing team. Uses specialist technical knowledge to evaluate and manage the validity of contracts and determine and manage the...

  • Regional Claims and Insurance Specialist

    4 weeks ago

    Cape Town, South Africa Transnet Full time

    **_ Equity Statement :Preference will be given to suitably qualified Applicants who are members of the_** **_designated groups in line with the Employment Equity Plan and Targets of the Organisation/Operating_** **_Division._** **_ Alternative Application Methods: (Completed Curriculum Vitae to be submitted)_** Post: E-mail: Fax: before the closing date of...

  • Senior Disability Claims Assessor

    7 days ago

    Cape Town, South Africa Old Mutual Full time

    Description Role Overview Use your specialist technical medical knowledge to assess risk for business and/or specific products. Uses specialist technical knowledge to evaluate and manage the validity of contracts and determine and manage the liability of claims (Assessor). Determines, selects and accepts risk and/or liability on behalf of the...

  • Senior Claims Assessor

    3 weeks ago

    Cape Town, South Africa Old Mutual Full time

    Description & Key Result Areas: Coaching Provide guidance and mentorship to junior claims assessors Personal Effectiveness Accountable for managing own time effectively to meet service delivery needs Prioritise tasks and ensure high-quality output Makes increased contributions by broadening individual skills Collaborates effectively with...

  • Claims Service Consultant

    4 weeks ago

    Cape Town, South Africa Sanlam Full time

    **Who are we?** 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...

  • Administrative Clerk

    7 days ago

    Cape Town, South Africa Santam Full time

    OPPORTUNITY Santam’s Legal Claims Solutions department has a position available for an Administrative Clerk who will be based in Bellville. WHAT WILL YOU DO? The Administrative Clerk will serve as the support function within the various business units (., support to the motor and non-motor recovery liability motor claims handler) and...

  • Forensic Planner

    4 weeks ago

    Cape Town, South Africa Kirby Group Engineering Full time

    **About Kirby Group Engineering** **Role Purpose** To work with internal Project Planning Teams to ensue project schedules, records and reports are setup and maintained in accordance with contractual requirements, internal best practices, enabling the preparation of prospective and retrospective delay and disruption analyses, providing effective delay and...

  • Commercial Manager

    4 weeks ago

    Cape Town, South Africa Outsourced Personnel Full time

    **RESPONSIBILITIES** - Manage the organisation commercial, contract administration, procurement and risk/opportunity functions - Manage client relations and be responsible for new business development and securing of additional work - Perform post contract award finalization - Manage the organizations project services including cost control, planning,...

  • Legal Counsel

    4 weeks ago

    Cape Town, South Africa TRS Staffing Full time

    A leading international multi-disciplinary Engineering company are recruiting for a Group Legal Counsel to join their team and be located in Cape Town, South Africa. Role Purpose As Group Legal Counsel you will be tasked with Providing group legal support across corporate governance, finance, bonding, structure, employment, litigation, commercial contracts,...

  • Head of Faculty: Humanities

    1 month ago

    Cape Town, South Africa Recruitment Full time

    Head of Faculty: Humanities (JB4188)Century CityMarket RelatedThe Head of faculty is responsible for full programme management for the portfolio of programmes in the faculty. This means accountability for programme development and curriculum reviews, assessment alignment and development, module material updates and prescribed textbook lists. The HOF is...

  • Group Payroll Administrator

    5 days ago

    Cape Town, South Africa Sea Harvest Full time

    **JOB PURPOSE**: Process the organisation’s payroll in a timely and accurate manner. Create and maintain employees’ payroll records. Calculating salaries/wages and applicable deductions based on employee attendance, sickness, tax liabilities and timesheet records etc. Enter payroll information into central system for processing. Completes payroll...

  • Assistant Director

    4 weeks ago

    Cape Town, South Africa Western Cape Government Full time

    **Job Purpose**: The Department of Cultural Affairs and Sport, Western Cape Government has an opportunity for a competent and suitably qualified individual to coordinate, review and undertake the implementation of financial accounting systems and procedures in line with relevant legislation, regulations frameworks and departmental policies and procedures. To...

  • Senior Key Accounts Manager/client Service

    4 weeks ago

    Cape Town, South Africa Viv Gordon Placements Full time

    The Senior Key Accounts Manager/Client Service Director will be responsible for achieving and exceeding the sales targets/financial sales budgets aimed at growing Key Account Sales and profits through the development of strategic business partnerships, which provide a total solution to the client from pre-media to print. You will be required to meet and...

  • Store Manager Managed People Solutions Cape Town

    4 weeks ago

    Cape Town, South Africa Managed People Solutions Full time

    **Managed People Solutions** is Looking to hire a** Store Manager **for a well-known liquor store based in **Cape Town.** **Job Purpose** To manage the efficient daily operation of the liquor store outlet in accordance with company policy and procedures **Responsibilities** - Assistance is provided to colleagues and customers - Referred customer queries...

  • Assistant Accountant: Assets

    4 weeks ago

    Bergrivier, Western Cape, South Africa Bergrivier Municipality Full time

    **BERGRIVIER MUNISIPALITEIT **Bergrivier Municipality ensures the wellbeing of all communities within the Bergrivier region through economic growth, social wellbeing, community** **involvement and effective management within a safe and healthy environment.** **Bergrivier Municipality with its head office in Piketberg and approximately an hour’s drive from...

  • Store Manager

    4 weeks ago

    Cape Town, South Africa Managed People Solutions Full time

    **Managed People Solutions** is Looking to hire a **Store Manager **for a well-known liquor store based in **Cape Town.** **Job Purpose** To manage the efficient daily operation of the liquor store outlet in accordance with company policy and procedures **Responsibilities** - Assistance is provided to colleagues and customers - Referred customer queries...

  • Account Manager

    4 weeks ago

    Cape Town, South Africa AdaptIT Full time

    Position reports to: Sales Manager Direct Reports: None Office Location National PURPOSE OF THE POSITION The Account Manager is responsible for selling the business’s products and services to our existing client base. He/she is responsible for implementing sales plans, documenting quotes, and reporting sales performance to the line manager. The Account...