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Claims Consultant

4 months ago

Sandton, South Africa Hollard Recruitment Full time

Hello… an exciting new opportunity has just become available in our Hollard Life Solutions, in the Operations & Claims Area We are looking to recruit a Claims Consultant

 

Job Purpose

  • To ensure that all risk claims are accurately assessed by applying agreed principles which are aligned to Insurance Industry standards
  • To ensure that our customers are treated with dignity as per the purpose statement and our service is aligned to Industry best practices.
  • Managing the Hollard’s risk by ensuring that valid claims are paid and invalid claims are not paid. Ensuring the correct claims are paid to the correct parties.
  • Managing our risk by verifying the information at sales, administration and claims stage and reporting operational risks to Compliance.
  • Comply with all Acts pertaining to 
  • Participate in the Dispute review committee for Business and TCF decisions.

 

Key Responsibilities:

  1. Full and accurate assessment of all life cover, disability, retrenchment, hospital, credit life and funeral claims required in terms of life claims principles & philosophies. Ensure all requirements have been received and that systems have been updated and that the correct value has been calculated.
  2. Application and interpretation of policy terms and conditions to assess claims correctly.
  3. Authorisation of claims within agreed mandate
  4. Verify, identify fraud and invalid claims.
  5. Ensure that required documentation for  FICA  is received and verified
  6. Identifying operational risk from sales , administration and claims and reporting it  to the manager.
  7. Ensure that queries are resolved timeously and correctly.
  8. Ensure daily targets are achieved and quality scores are above 95% each month.
Outputs
  1. Full and accurate assessment of all claims required in terms of life claims principles & philosophies.
  2. Ensure all requirements have been received; Standard Operating Procedures applied and the correct value has been calculated.
  3. Application and interpretation of policy terms and conditions.
  4. Authorisation of valid claims within agreed mandate on line of business system.
  5. Maintaining clear and consistent communication with internal & external parties regarding pending claims and requirements thereof
  6. Liaising with internal investigation team on claims where further assistance is required
  7. Ensuring that all line of business systems are updated and that all necessary notes have been made on the relevant systems
  8. Maintaining professional telephonic and written communication with customers and internal stakeholders.
  9. Ensuring that final assessed claims are timeously submitted for payment/repudiation after a decision has been entered on the claims system
  10. Compilation of daily stats to Team leader
  11. Maintaining turnaround times in terms of Service Level agreements and meeting team KPI’s