Senior Claims Liaison

4 days ago

Johannesburg, South Africa PPS Recruitment Full time

**Job Advert Summary**:
This role reports to the Executive Claims Assessor. The role will transfer specialist claims knowledge, in-depth process knowledge and client centric principles to the claims team by conducting, quality assurance and post audit entrenchment. Conduct training session for the claims team and other internal and external stakeholders and provide technical input to improve claims assessing.

The incumbent will deal with technical and complex claims queries and/or complaints providing an excellent service offering. A close relationship with Research & Development to support interdepartmental and wider organizational goals.

**Minimum Requirements**:
**Education**:

- Degree in Occupational Therapy or Physiotherapy or any other medical/health quality.

**Experience**:

- 8+ years’ experience in the insurance industry.
- 5+ years’ experience in claims assessment including Income protection, Lump Sum Disability, and dread disease.
- Prior experience in Sales Support and Risk Management is advantageous.

**Knowledge and Skills**:

- Capable of critically evaluating data to derive meaningful, actionable insights.
- Demonstrate superior communication and presentation capabilities for audiences without a technical background.
- Must have excellent telephone etiquette.
- Good computer knowledge - MS Outlook, Excel and Word are necessary.
- Good report writing and presentation skills.
- Must have a mature, disciplined, and driven personality.
- Ability to work independently as well as being a good team-player with excellent interpersonal skills.
- Deadline/target driven, with ability to work under pressure.
- Logical and analytical.

**Competencies**:

- Adept at report writing and presenting findings.
- Planning and organizing.
- Attention to detail.
- Client centricity.
- Building and maintaining relationships.
- Resilience.

**Duties and Responsibilities**:
**Claims Processing and Resolution**:

- Analyze claims data, identify trends, and provide recommendations for improving claims processing and resolution.
- Investigate, evaluate, and negotiate complex insurance claims in a timely and efficient manner.
- Liaise with policyholders, claimants, and other stakeholders to gather necessary information and documentation to process claims.
- Ensure compliance with company policies, procedures, and regulatory requirements.

**Internal Arbitrator and Ombudsman**:

- Act as an internal arbitrator and ombudsman to assist stakeholders (e.g., policyholders, agents, brokers) with claims-related queries and issues.
- Facilitate the resolution of disputes and complaints through mediation and negotiation.
- Provide guidance and recommendations to stakeholders to ensure fair and equitable claim outcomes.
- Maintain detailed records of all arbitration and ombudsman activities.

**Stakeholder Liaison**:

- Collaborate with various departments and stakeholders to ensure seamless communication and coordination in the claims process.
- Provide presentations on request.
- Contribute to the development of claims-related policies, procedures, and training materials.

**Presentations and Quality Assurance**:

- Analyze quality assurance data and provide recommendations to enhance the overall claims management system.
- Conduct regular quality assurance reviews of claims processes and documentation to identify areas for improvement.
- Prepare and deliver presentations to management, cross-functional teams, and other stakeholders on claims-related topics.
- Convey insights through both reports and visual presentations.
- Provide constructive feedback to claims manager/-claims team regarding matters arising.

**Knowledge Sharing and Champion**:

- Regularly share key learnings, best practices, and process improvements with the claims team and other relevant departments.
- Participate in team meetings, training sessions, and cross-functional initiatives to promote knowledge sharing and continuous improvement.
- Stay up-to-date with industry trends, regulatory changes, and emerging claims management practices.
- Provide guidance and support to claims assessors.
- Empower team members with transfer of knowledge, be the Claims Team SME.
- Ensure that own knowledge is kept abreast with industry & regulatory information and changes through various internal and external information sources. Regulations to provide informed and up-to-date support.
- Provide technical information and support. Proactively identify opportunities to enhance claims processes and communication strategies.

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