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Complex Claims Specialist
3 months ago
Hello… an exciting new opportunity has just become available in our Hollard Insure , in the Operations
area. We are looking to recruit a Complex Claims Specialist
Role Objectives:
• Process all complex claims assigned, with a focus on all claims above Branch Mandate, within the set
standards required by the company thus contributing to the effectiveness and efficiency standards
of the Team, and the Company at Large.
• Managing complex claims according to the CCU Project Methodology, mitigating risk, and managing
budget, engaging with key stakeholders, and tracking timeline against Claims Framework
• Enhance the image of the company through the continuous delivery of efficient and effective
customer service.
• Ensure all technical aspects & specialist functions for claims management and fulfilment are
adhered to.
Key Responsibilities:
• Technical expertise: To effectively validate Large Losses against Policy provisions, and general policy
conditions and requirements with a view on fair settlement, and simultaneously ensure prevention
and mitigation of leakage to the company. . Manage claims end- to-end.
• Use knowledge and Skill to evaluate and validate all Complex Claims.
• Stakeholder Management: Maintain a high level of service to all stakeholders identified (internal and
external) according to their respective SLA’s.
• Reporting: Provide necessary reporting on financial and operational indicators relating to claims,
keep all records and registers up to date. Provide feedback (reporting) to senior management on
achievements, pending issues, concerns, and suggested recommendations.
• Effective and timeous communication: Communicate in a professional manner with internal and
external parties and respond to queries within 24 hours. Keep concerned parties abreast of claims
status and development, utilising the Project Management Methodology as represented in the Pack
making up a POE (Portfolio of Evidence)
• Estimate Management: to ensure that estimates loaded are accurate, justified by means the
necessary supporting documentation, monitored and managed.
• Must have a good understanding of Treaty vs Fac Reinsurance.
• Risk management: Can spot an adverse risk, to enable suggestions for future risk mitigation.
• Facilitating monthly triangulate meetings between claims, risk, and underwriting
• Recordkeeping & Reporting: As and when requested.
• Quality control: Quality standards to be adhered to always
Relationship management: Working with and support the claims teams in the regional offices as well
as managing relationships with loss adjustors and specialists.
• Continuous Process Improvement: Ensure full compliance to all processes, policies and procedures
and identify areas for improvement.
• Variance Management: Adhere to standards set by Hollard. Provide action plans and follow up with
corrective actions to all variances.
• Employee Growth: Take responsibility for your own career growth and have regular discussions with
the relevant stakeholders.
