Claims Consultant: Business Insurance: Jhb

Telesure Investment Holdings (Pty) Ltd (TIH), is the holding company of some of South Africa’s leading financial service providers. Our portfolio includes short-term insurers, a long-term insurer, health insurance as well as an insurance and personal finance comparison platform. Our origins date back to 1 June 1985, and we have since grown into a group of subsidiaries that includes some of South Africa’s most loved and recognisable brands. We exist to continuously find better ways to give people peace of mind, whether it is to protect what they own, their loved ones or their greater ambitions and life plans. We bring customer-focused innovation and service excellence to the financial services industry. We’re an undivided team who believe in leading through technology and pushing past their limits. TIH is owned by BHL (SA) Holdings Limited. BHL has a vast global footprint.

**JOB PURPOSE**

Process already-captured claims efficiently and accurately through drawing on the relevant criteria to ensure standardisation across the organisation to enable decision making on a claim.

**RESPONSIBILITIES**

**Customer Management (Internal)**

Help manage customer by carrying out standard activities to complete the customer request.

**Data Collection & Analysis**

Ask questions, collect data from a variety of sources, analyse information and investigate claim. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools (ITC, supplier contract and/or negotiation) to accurately cost applicable claims on a day-to-day basis.

**Work Scheduling and operational compliance**

Organize own work schedule in order to get the job done, coordinating with support services and completed work within SLA. Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately). Remain up to date current and new product knowledge to enable effective decision making.

**Administration**

Produce, update, and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.

**Correspondence**

**Document Management**

Create, organize, and maintain files containing the correspondence relating to policies and matters.

**Document Preparation**

Prepare and manage claim documentation for customers.

**TECHNICAL COMPETENCIES**

**Verbal Communication**

Uses clear and effective verbal communications skills without supervision and provides technical guidance when required on expressing ideas, requesting actions and formulating plans or policies.

**Numerical Skills**

Uses an understanding of numerical concepts to perform mathematical operations such as report analysis with guidance (but not constant supervision).

**Computer skills**

Supports business processes without supervision by understanding and effectively using standard office equipment and standard software packages, while providing technical guidance as needed. Basic computer skills; Microsoft Office Basic.

**Planning and Organizing**

Works without supervision and provides technical guidance when required on planning, organizing, prioritizing, and overseeing activities to efficiently meet business objectives.

**Policy and procedures**

Works with guidance (but not constant supervision) to develop, monitor, interpret and understand policies and procedures, while making sure they match organizational strategies and objectives.

Knowledge of claims policy and procedures.

**Action Planning**

Works with guidance (but not constant supervision) to develop appropriate plans or perform necessary actions based on recommendations and requirements.

**Data Collection and analysis**

Works under guidance to analyse data to critically evaluate information to ensure accuracy of content.

**Internet browser knowledge**

Applies concepts of knowledge / skill without requiring supervision; also, able to provide technical guidance when required.

**EDUCATION**
- General Education Matric / Grade 12/ SAQA Accredited Equivalent (Essential)
- Regulatory exam 5 (Essential)

**EXPERIENCE**

**General Experience**
- 1-3 years Financial Services industry experience (Essential)
- STI experience and commercial/ business insurance (Advantageous)

**TASKS**
- Prepare insurance claim forms or related documents and review them for completeness.
- Enter claims information into database systems.
- Calculate amount of claim
- Post or attach information to claim file.
- Contact insured or other involved persons to obtain missing information.
- Review insurance policy to determine coverage.
- Organize or work with detailed office records, using computers to enter, access, search or retrieve data.
- Organize or work with detailed office records, using computers to enter, access, search or retrieve data.
- Finalise claims and send to services department.
- Listen an