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Claims Fulfillment Consultant

1 month ago

Durban, South Africa Pronel Personnel Full time

Job Purpose
We pride ourselves on our superior customer experience to all our customers, whether internal or external, by applying the highest technical claims knowledge and systems understanding when resolving claims and providing support. Our area of expertise consists of building claims. The inherent goal is to consistently exceed and practice customer expectations as governed by regulations on a regular basis and to drive timeous settling of claims, whilst applying risk management principles at a consultant level.

A. Claims Processing
The following directly centers around your daily obligations:
• Authorise claims within the set mandate and resolve all claims within the agreed productivity targets and turnaround times by utilising the claims diary system effectively.
• Apply and effectively communicate technical skills and resolve all technical issues using available tools and systems.
• Demonstrate a clear understanding and execution of customer complaints and resolutions that must be maintained and exceeded, as well as a clear understanding of claim rejections.
• Demonstrate a clear understanding of the management of claims handling that must be followed within the regulated agreements as specified by the relevant regulatory boards.
• Ensure a clear understanding of all payments, the correct application of rates to be authorised to the service provider and the correct appointment of service providers to the claims.
• Demonstrate a thorough understanding of the report and quotes to communicate prompt claims resolution to the customer.
• Have a clear understanding of how to operate a claims management system, as well as the use of relevant tools that can enable the quick resolution of a claim and ensure effective communication, such as using Outlook to send emails, SMS and exporting own reports to Excel.
• Have a working knowledge of the internet and how to use Google Maps.

B. Plan, Communicate, Solve Problems and Effectively Carry Out Decisions
• Ensure that all customers are treated fairly and have a clear understanding and accurate interpretation of the reported incident, claims history and correct application of the policy wording.
• When communicating technical detail to the Customer, Loss Adjusters to consult or debate the outcome of the claim, ensure lateral thinking and professional engagement with all parties.
• Have an inquisitive and investigative mind to communicate and report suspicious activity to the next reporting level if further intervention is required.
• Possess the ability to communicate calmly and professionally, yet assertively with difficult customers at all levels and outcomes in a fair, sensitive and persuasive manner, always keeping in mind that the customer must be treated fairly as required.
• Have a clear understanding of how to engage and communicate with the appropriate specialist service providers to engage on each claim, such as engineers, etc.

C. Practice and Promote Consistent Effective Relationship Building
Maintain effective relations with all stakeholders within the organisation. This includes but is not limited to:

Internal Daily relationships with:
• Finance Division to improve on service delivery issues regarding payment authorisations
• Customer Contact Centre to assist and improve customer communication, complaints and technical support, as well as provide and assist with advice on any noted anomalies or trends that could affect the processing of new claims and identify risks associated
• Policy Administration for advice of any policy amendments, client queries/requests and complaints resolution
• Management and peers to provide daily interactions about any contentious matters and or report on urgent claims that require attention or authorisation
• Procurement Manager, to ensure that service providers strictly adhere to the current service level agreement
• Claims Fulfillment Manager, to guide, assist, mentor and advise on all matters that can assist you with your growth. 
• Operations Manager, to guide, assist and advice you through your first line report, in line with your growth and any other communication in terms of your claims

External Daily relationships with:
• Customer Service: provide exceptional customer experience throughout the customer journey and assist by providing professional peace of mind while dealing with queries or providing feedback proactively.
• Panel or non-panel service providers; relationships ensure professional customer service interaction, with loss adjusters, quantity surveyors, forensics experts, etc. and various specialists required to complete the claim successfully
• Representatives to provide assistance and resolve customer issues.
• Internal and external auditors to provide assistance during interim or final company audits.

 

Minimum Requirements:
• The candidate should respond on technical aspects of the policy and be able to translate from reports and respond accurately to the customers accordingly.

 

Minimum Education Qualification:
• Matric

 

Preferred Qualification:
• Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5

 

Minimum Experience:
• 4 years Claims experience, preferably Homeowners/Building Claims experience.


Preferred Experience:
• 5 years Short Term Claims Insurance related experience, preferably with Homeowners/Building experience

 

If you meet all of the above criteria, please apply directly here OR send your CV to recruit@pronel.co.za

Please note: due to high volume responses, only candidates that meet the advertised criteria will be contacted.

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