Claims Specialist

4 weeks ago

Sandton, South Africa Sanlam Full time

What will you do?

We have an exciting opportunity for the Claims Specialist within SHA Risk Specialists.

What will make you successful in this role?

Key responsibilities:

Claims Practice Management:

Attend and manage all aspects related to a portfolio of specialist claims such as claims registration, case management, drafting, diary, recoveries, and settlement negotiations. Draft settlement agreements and other legal documents within mandate as per the Claims Governance Folder. Strategically manage a portfolio of claims. Manage loss adjusters and attorneys appointment on matters and ensure compliance with agreed service level agreements. Monitor and manage legal spend of attorneys and loss adjusters. Manage system processing and compliance with systems by way of payments, updating signed off reserves, proper recordal of information etc. Attend to Operational duties as allocated  Compile and manage risk reports when required Actively manage and record claims above certain thresholds as per The Claims Governance Folder and report on matters to Claims Co and Executive where required. Comply with internal and external regulatory framework and internal and external processes and procedures in accordance with organisational standards. Draft processes and procedures that are compliant with relevant regulatory framework and applicable legislation.  Effectively liaise and interact with Underwriters. 

Analysis:

Consider, analyse and interpret insurance policy and the contractual impact thereof for the determination of coverage; Critically analyse the facts of the matter and their impact on the underlying policy. Draft opinions on the interpretation of coverage in relation to the facts and the applicable policy, present and motivate; Draft opinions on merits and quantum of matter with the relevant caselaw and legislation applicable; Apply critical thinking to ensure appropriate decisions on merits, quantum and policy response. Critically consider and evaluate information provided and identify information required. Conduct a strategic assessment of claims and make strategic decisions and recommendations on handling of claims. Develop and maintain an understanding of technical and legal aspects impacting on the policy’s operation. Make representations and recommendations on improved wording and trends identification to underwriters

Individual Claims Leadership:

Be involved in continuous training and development in respect of Case Law, Policy wording, etc.  Assist in identifying and developing SOP’s and processes to ensure claims department effectiveness. Take initiative in creating opportunities of interaction with Brokers and Insureds. 

Client Liaison (Internal and External):

Liaise with clients to resolve queries to the satisfaction of the affected parties within the scope of authority and / or responsibility. Prepare for and attend meetings and consultation with brokers, insureds, legal representatives and loss adjusters.

Skills and Competencies

Administrative Skills  Analysis and Judgement  Attention to Detail  Client Orientation  Communication Skills including negotiation  Follow Up  Initiative  Interpersonal Skills  Organisational Awareness  Planning and Organising  Teamwork  Computer Literacy Ability to strategise and drive a claim to finality

Qualifications & Experience

Matric  Law Degree  Admitted attorney  FAIS compliance a preference  Previous non-motor liability claimshandling experience 

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