Loss Adjuster

3 weeks ago

Cape Town, South Africa Nedbank Full time

**Job Classification**
- X2 Positions- Based in Cape Town and Johannesburg- Job Family- Administration, Operations and Facilities
- Career Stream- Operations
- Leadership Pipeline- Manage Others
- FAIS Affected**Job Purpose**
- To manage, control and attend to contractor audits, authorizations over-mandate, upfront assessments, customer complaints and enforce correct interpretation of the Homeowners Insurance Policy with panel service providers and clients. Perform a mentoring and coaching support function to Nedbank Insurance, service providers and clients on products and technical aspects where specialised knowledge is required in resolving intricate challenges regarding claims relevant to Homeowners Insurance Cover.**Responsibilities**:

- **Assessments of claims**: Advise and provide technical support to Nedbank Insurance's claims, underwriting, product and client experience departments;
- Minimizing claim losses on within and over-mandate claim; Assess, audit and authorize claims in terms of allowable rates;
- Ensuring that the claims authorization mandate per claim is adhered too.
- Quantification by either drafting a scope of work and finalizing the cost of the claim according to agreed rates or comparing quotations and reports received from service providers and clients compared to the scope of work and rate guide.
- Managing the cost from the start of the claim until the claim is finalized within the set parameters and agreed scope of work;
- Handling and resolving complaints and queries from clients, internal stakeholders as well as external stakeholders such as builders, engineers etc.
- **Risk Management**: Detect and identify fraudulent claims and any overcharging by clients and service providers; Perform risk management function by identifying underwriting risks and inadequate Sum Insured's of dwellings; Ensure adherence to all legislative requirements.

**People Specification**
- **Policy interpretation of Homeowner's Insurance Cover**.
- **Vendor Management**: Training of service providers (policy wording, processes and rates); Monitoring of service providers (report writing, policy interpretation, claims costs and service); Maintaining and sustaining good business relationship between service providers, clients, Broker Support.
- **Reporting and operational efficiency**: Ensure quality and accuracy of reports, pricing and workmanship rendered by service providers;
- Effectively utilize the daily new claims repot to assist in identifying opportunities for further claims assessments.
- Finalise all reports and administration within agreed turnaround and internal service level agreements.
- **Keeping technical skills current and stay abreast fo any changes to legislation relevant to Home Owners.**:

- **Arbitrations, second opinions and disputes**: Short-Term Insurance Ombudsman matters that require further investigation; Clients proving to the contrary with rejected claims; Complaint against service provider; Client not happy with valuation (insurance replacement cost); As a result of the high cost of second opinions the internal assessor is to ensure that the service providers are suitably skilled and trained.
- Essential Qualifications - NQF Level- Matric / Grade 12 / National Senior Certificate
- Preferred Qualification- **3 year Construction Technology certificate/ Diploma or**:

- **4 year Building Science or Construction Degree**:

- **Training Courses: Fire Investigation, Kwikot Benchmark training advantageous**
- Essential Certifications- Preferred Certifications- Minimum Experience Level- **3 years related working experience as a loss adjuster or internal assessor handling building or personal lines insurance claims.**

Working conditions

**Environment **-Internal loss adjusters inspect domestic dwellings and outbuildings which includes climbing onto roofs( single, double etc) and into ceiling voids for inspection purposes

**Travel** - They are predominantly on the road travelling from one inspection to another. On occasions they travel to visit service providers for queries or conducting training. During the year they are required to travel ‘out of town’ (other provinces) to conduct audits in areas where there are no internal loss adjusters.

**Time Flexibility** - The Internal Loss Adjuster is required to work flexible hours to accommodate home owners with site inspections. During an insurance catastrophe the internal loss adjuster may be required work after hours.

Working Conditions
- The internal loss adjuster has to climb on to roofs and into ceiling voids which may be required during claim inspections.

**Technical / Professional Knowledge**
- Banking knowledge
- Business Acumen
- Data analysis
- Governance, Risk and Controls
- Industry trends
- Principles of financial management
- Principles of project management
- Relevant regulatory knowledge
- Relevant software and systems knowledge
- Decision-making process
- Behavioural Competencies- Building Partnerships
- Earning

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