Technical Claims Specialist
3 days ago
**Introduction**
**Role Purpose**
**Requirements**:
- Matric /Grade 12
- Relevant Insurance Experience (Overall Insurance knowledge)
- LLB Advantageous
- Certificate in Insurance Advantageous (NQF 5)
- At least 5 years 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 Brilliance 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**
- Collaborative
- Good communication skills
- Analytical
- Business Acumen
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