Claims Technical Specialist

1 week ago

Sandton, South Africa Momentum Metropolitan Holdings Full time

Introduction

Role Purpose

**Requirements**:

- Matric
- Relevant Insurance Experience (Overall Insurance knowledge)
- LLB Advantageous
- Certificate in Insurance Advantageous (NQF 5)
- Minimum 5 years in a technical claims environment
- Previous Short Term Claims Experience in a senior role

Duties & Responsibilities
- Review and monitoring of large loss claims from UMA’s and NMI’s;
- Provide general claims handling guidance to external stakeholders including liability claims ;
- Identify claim trends across multiple stakeholders and escalating to portfolio managers/ Market Conduct;
- Attending to OSTI matters;
- Provide technical claim expertise to stakeholders where required;
- Attend to Ad-Hoc tasks that may be assigned from time to time;
- Attend to client reviews with specific focus on claims handling processes/suppliers management/operational risks and adherence to SLA’s between Guardrisk and other related third parties; ensuring risk management of portfolio is attended to,
- Monitoring of loss ratio’s across all portfolios under your management and providing assistance and guidance to stakeholder on corrective steps to be actioned if loss ratio not favourable
- Review and approval of non-mandated intermediary rejections;
- Ensure that rejections/complaints/rejection representations recorded on the Respond system;
- Attend to litigation matters;
- Attend to representations following claim rejections;
- Attend to general claim complaints;
- Attend claim/operational meetings with stakeholders and portfolio managers;
- Preparing and attending to monthly report as assigned ;
- Identify gaps in policy wordings and making recommendations for changes where necessary;
- _Ex-gratia_ claim approval
- Handling of _SASRIA_ claims
- Managing stakeholder relationships - internal and external

Competencies
- Analytical thinking
- Negotiation skills
- Customer Orientation
- Building Relationship
- Influencing
- Time management
- Self -motivated
- Disciplined

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

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