Job Description

Job Summary 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: xe2x80xa2 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. xe2x80xa2 Apply and effectively communicate technical skills and resolve all technical issues using available tools and systems. xe2x80xa2 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. xe2x80xa2 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. xe2x80xa2 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. xe2x80xa2 Demonstrate a thorough understanding of the report and quotes to communicate prompt claims resolution to the customer. xe2x80xa2 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. xe2x80xa2 Have a working knowledge of the internet and how to use Google Maps. B. Plan, Communicate, Solve Problems and Effectively Carry Out Decisions xe2x80xa2 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. xe2x80xa2 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. xe2x80xa2 Have an inquisitive and investigative mind to communicate and report suspicious activity to the next reporting level if further intervention is required. xe2x80xa2 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. xe2x80xa2 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: xe2x80xa2 Finance Division to improve on service delivery issues regarding payment authorisations xe2x80xa2 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 xe2x80xa2 Policy Administration for advice of any policy amendments, client queries/requests and complaints resolution xe2x80xa2 Management and peers to provide daily interactions about any contentious matters and or report on urgent claims that require attention or authorisation xe2x80xa2 Procurement Manager, to ensure that service providers strictly adhere to the current service level agreement xe2x80xa2 Claims Fulfillment Manager, to guide, assist, mentor and advise on all matters that can assist you with your growth. xe2x80xa2 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: xe2x80xa2 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. xe2x80xa2 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 xe2x80xa2 Representatives to provide assistance and resolve customer issues. xe2x80xa2 Internal and external auditors to provide assistance during interim or final company audits. Minimum Requirements: xe2x80xa2 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: xe2x80xa2 Matric Preferred Qualification: xe2x80xa2 Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5 Minimum Experience: xe2x80xa2 4 years Claims experience, preferably Homeowners/Building Claims experience. Preferred Experience: xe2x80xa2 5 years Short Term Claims Insurance related experience, preferably with Homeowners/Building experiencePronel PersonnelRecruiter

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