Insurance Claims Resolution Manager

4 days ago


Umhlanga, KwaZulu-Natal, South Africa Simply HR Payroll Full time
Insurance Claims Resolution Manager

A leading home loan and insurance provider seeks an experienced Insurance Claims Resolution Manager to excel in their team. The primary objective is to consistently deliver exceptional customer experiences while adhering to regulatory guidelines, ensuring efficient claims resolution through effective risk management practices.

Main Responsibilities
  • Authorise claims within established parameters, resolve all claims within agreed productivity targets and turnaround times using the claims diary system efficiently.
  • Apply technical skills and communicate effectively to resolve technical issues utilizing available tools and systems.
  • Maintain a clear understanding and execution of customer complaints and resolutions, as well as claim rejections, to ensure excellent customer service.
  • Understand and follow regulated agreements specified by relevant regulatory boards for claims handling.
  • Evaluate payments, apply correct rates to authorized service providers, and appoint service providers correctly for claims.
  • Demonstrate thorough understanding of reports and quotes to provide prompt claims resolution to customers.
  • Operate a claims management system, utilize relevant tools for quick claim resolution, and ensure effective communication, such as sending emails via Outlook and exporting reports to Excel.
  • Familiarity with the internet and Google Maps usage.

Key Skills: Effective Communication, Problem Solving, Time Management.

Key Responsibilities
  • Treat all customers fairly, maintaining a clear understanding and accurate interpretation of reported incidents, claims history, and policy wording application.
  • Communicate technical details to customers and Loss Adjusters, ensuring lateral thinking and professional engagement with all parties.
  • Employ an inquisitive and investigative mindset to report suspicious activity to the next level if further intervention is required.
  • Ability to communicate calmly and professionally yet assertively with difficult customers at all levels and outcomes, treating customers fairly as required.
  • Familiarity with engaging and communicating with specialist service providers, such as engineers.
Collaborative Working
  • Maintain effective relationships with stakeholders within the organisation, including:

Internal

  • Finance Division to improve service delivery regarding payment authorisations.
  • Home Loans Customer Contact Centre to assist and enhance customer communication, complaints, and technical support.
  • Policy Administration for policy amendments, client queries/requests, and complaints resolution advice.
  • Insurance Customer Contact Centre to provide assistance on noted anomalies or trends affecting new claims processing and identify associated risks.
  • Management and peers to discuss contentious matters and report urgent claims requiring attention or authorisation.
  • Procurement Manager to ensure service providers adhere to the current service level agreement.
  • Claims Fulfilment Manager for guidance, assistance, mentorship, and advice on growth and matters that can aid your development.
  • Operations Manager for guidance, assistance, and advice on growth and other communications related to claims.

External

  • Customer: Provide exceptional customer experience throughout the customer journey and assist in providing professional peace of mind when dealing with queries or feedback proactively.
  • Panel or non-panel service providers: Ensure professional customer service interaction with loss adjusters, quantity surveyors, forensics experts, etc., and various specialists required for claim completion.
  • Sales Representatives to resolve customer issues.
  • Internal and external auditors for assistance during interim or final company audits.
Culture and Development
  • Pride in the company's mission, vision, and values must be taken seriously. Personal development and career path are crucial, following the company's code of ethics to improve reputation and brand.
  • Compliance with organisations' and regulatory boards' regulations and legislation. Understanding, supporting, and living the organisation's Amazing Service Culture is essential.

The ideal candidate should respond to technical aspects of policies and translate from reports accurately to respond to customers accordingly.

Requirements
  • Grade 12 qualification.

Preferred Qualification:

  • Insurance-related qualifications, e.g. FETC: Short Term Insurance NQF 4, RE5.
  • 4 years Claims experience, preferably Homeowners/Building Claims experience.

Preferred Experience:

  • 5 years Short Term Claims Insurance-related experience, preferably with Homeowners/Building experience.
  • Building/Homeowners Claims and Customer Service-oriented.
  • Computer Literacy, Excel, Word, Microsoft Outlook.
  • Claims Management and ability to navigate systems effectively.
  • Understanding and communicating technical matters analytically.
  • Excellent verbal and written communication skills.


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