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Claims Resolution Specialist

1 week ago

Durban, KwaZulu-Natal, South Africa Future Careers Full time
Job Description

The role of a Claims Consultant in the Insurance industry is to ensure that claims are processed efficiently and effectively.

Key Responsibilities:

  1. Authorize and resolve claims within agreed productivity targets and turnaround times by utilizing the claims diary system.
  2. Apply technical skills and resolve issues using available tools and systems.
  3. Demonstrate a clear understanding of customer complaints and resolutions, as well as claim rejections.
  4. Manage claims handling according to regulated agreements.
  5. Ensure accurate payments, correct application of rates, and appointment of service providers.
  6. Operate a claims management system and use relevant tools for quick resolution and effective communication.
  7. Have a working knowledge of the internet and Google Maps.

Additionally, this role involves:

Planning, Communication, Problem-Solving, and Decision-Making.

  1. Treat customers fairly, with a clear understanding of incident reports, claims history, and policy wording.
  2. Communicate technical details to customers and Loss Adjusters, ensuring professional engagement.
  3. Investigate suspicious activity and report it to the next level if required.
  4. Communicate calmly and professionally with difficult customers, always treating them fairly.
  5. Engage with specialist service providers, such as engineers.

This includes daily interactions with:

Finance Division for payment authorizations and service delivery improvement.

Policy Administration for policy amendments, client queries, and complaints resolution.

Insurance Customer Contact Centre for advice on anomalies and trends affecting new claims processing.

Management and peers for contentious matters and urgent claims.

Procurement Manager for adherence to service level agreements.

Claims Fulfillment Manager for guidance, mentoring, and advising on growth opportunities.

Operations Manager for guidance and advice through reporting lines.

External Daily relationships include:

Providing exceptional customer experience and professional peace of mind.

Interacting with panel or non-panel service providers, Loss Adjusters, Quantity Surveyors, and Forensics Experts.

Assisting Internal and External Auditors during audits.

Values and Self-Development:

  1. Pride in the company's mission, vision, and values.
  2. Taking charge of personal development and career path.
  3. Following the company's code of ethics.
  4. Complying with regulations and legislation.
  5. Supporting and living the organization's Amazing Service Culture.
  6. Carrying out fair and reasonable instructions within prescribed turnaround times.