Accident & Health Claims Examiner at AIG

PRINCIPLE DUTIES AND RESPONSIBILITIES:
Claims Administration

• Register the Claim according to procedure
• Set appropriate reserves in line with policy
• Determine if the loss is covered in terms of the policy
• Assess the Claim based on accurate interpretation of policy wording in place: refer Claims outside Claims mandate
• Appoint / recommend appointment of loss adjusters and/or relevant experts: provide appropriate settlement instructions
• Follow Claims settlement process to ensure timely settlement of Claims and fees
• Conduct timely, professional follow-up correspondence with Clients and Brokers, including Claims rejection
• Provide reports to Claims Manager in line with Claims policies

Customer Service

• Establish and maintain excellent levels of customer service, with particular attention to:
• Responsiveness – speed of service delivery
• Quality of service rendered
• Adherence to internal and external SLA’s

Audit and Compliance

• Ensure adherence with and implementation of all claims compliance controls as may be specified from time to time by the Claims Manager

QUALIFICATIONS:

• Matric
• Short Term Insurance qualification preferred
• FAIS compliant

EXPERIENCE:

• Minimum of 3 years experience as Claims Examiner, including experience in specific Line of Business, as appropriate.