Description
The ideal candidate for this role should be highly-analytical and possess an in-depth knowledge of policies and regulations in the insurance industry. S/he must be able to work in a fast-paced environment.
Key Responsibilities:
Analyze and investigate complicated insurance claims to help prevent fraud.
Providing advice on making a claim and the processes involved.
Processing new General Business claims notifications.
Collecting accurate information and documents to proceed with a claim.
Where possible / appropriate obtain check the validity of the information provided by the claimant, consultants and other sources.
Interpretation of the policy wording and policy schedule to determine the extent of coverage and the application of any warranties, conditions or exclusions.
The identification and collection of any policy excess/deductibles.
Analyzing the claim made by a policy holder or third party and guiding policyholders on how to proceed with the claim.
Show respect, compassion and integrity to achieve a reasonable settlement and protect the brand.
Engaging people from a network of approved professionals ranging from repairers to lawyers, loss adjusters and medical adviser and arranging for them to make repairs or provide reports on the extent of the damage, loss or injury.
Reading to comprehend, loss adjusters, lawyers and expert opinion reports and ensuring they are complete and logical.
Monitoring the progress of a claim; investigating potentially fraudulent claim and identifying reasons why full payment may not be made.
Minimize claims leakage; that is the over payment of claims or consultant fees or the payment of a non-valid claim.
Ensuring fair and prompt settlement of a valid claim by the insured.
Negotiating a prompt and commercially sound settlement with third party claimants.
Building relationships with loss adjusters, forensic accountants and solicitors, as well as other legal/claims and consulting professionals.
Ensuring the customer is treated fairly and that the customer receives excellent service in accordance with industry and company guidelines.
Involvement in loss adjusting and legal discussions relating to settlement;
Seeking legal recovery of monies paid out.
Taking responsibility for productivity and profit.
Providing claim reports that will enable strategic decision-making and business improvement
Adhering to legal requirements, industry regulations and customer quality standards set by the Management.
Requirements
Good First Degree in Insurance or related field.
Proficiency in the use of Microsoft Office.
Minimum of 2 years’ Cognate experience as a Claims Officer or similar role.
Ability to work with minimal supervision and pay attention to details.
Good business writing and communication skills
Excellent team management skills
Strong attention to details
Willingness to learn on the job
Excellent customer service skills
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