Claims Assessor : Non Motor (Limpopo) at Old Mutual

Job Description

Purpose of the Job

• This role effectively investigate, adjust and report on assigned claims, thus ensuring containment of claims spend on providing excellent service in setting a culture of best practice within mandated responsibility.
• The role of assessor is to determine validity and settlement of a claim by establishing merit, verifying quantum, and agreeing on type of indemnification. Through-out the indemnification process, the Field Assessor will be liaising with Brokers / Clients/ Back Office Negotiators/ Incident Managers / Moderators / Salvage Vendors / Old Mutual Insure Approved Suppliers / Contractors to aid in the finalization of the claim.

Key Responsibilities:

• Due care - ensure that those who have suffered a loss receive all the benefits and assistance to which they are entitled to in terms of their policy in force.

Assessments:

• Conducting detailed onsite investigations of a loss and or damage and determining how it occurred.
• Conducting witness interviews when necessary.
• In respect of a building claims, taking own measurements and drafting of estimates on the relevant platforms.
• In respect of contents claims, obtaining market related quotations.
• Obtaining all necessary supporting evidence to substantiate the claim outcomes.
• Property policy cover interpretation and application is essential.
• Report writing - compiling a comprehensive report of the loss or damage, referring to supporting evidence and conclusive outcomes.
• Quantification – comprehensive quantification of losses, with detailed scope of works and adherence to various moderation processes.
• Outcome – having meaning outcome discussions with clients, whether a claim is settled or being rejected.
• Adequacy – calculating the adequacy of the sum insured, of both building and contents, at the time of a loss.
• Risk mitigation – making risk related recommendations for underwriting consideration.
• Communication – clear and concise communication throughout the assessment process, making sure that all stakeholders are informed.
• Supplier base – making use of the approved panel of service providers; fair rotation of work is critical.
• Upskilling – to remain relevant it’s important to continually improve on your skills and abilities.

Experience, knowledge & skills required 

• National Senior Certificate (NSC)
• Higher Certificate in Short- Term Insurance (NQF 5)
• 3- 5 years Non-Motor Claims Assessment experience,
• Certified and Accredited Fraud Examiner (ACFE),
• Valid South African Drivers Licence

Responsibilities
Insurance Claims Administration

• Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.

Insurance Claims Evaluation

• Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.

Fraud/Financial Crime Investigation

• Contribute to the investigation of cases of suspected fraud or financial crime by gathering, analyzing, and retaining information and physical evidence to support criminal investigation and/or legal action. Recommend further actions to the lead investigator.

Fraud/Financial Crime Management

• Analyze data to identify and track and report key trends in activities or transactions that indicate high risk of fraud, and report any specific instances of suspicious activity to more senior colleagues.

Operations Management

• Provide operational support services and sometimes act as first-line supervisor of a transactional operations area. Involves using existing systems and protocols.

Solutions Analysis

• Interpret data and identify possible answers. Involves navigating a wide variety of processes, procedures, and precedents.

Document Preparation

• Organize and prepare complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for special reports.

Resolving Customer Issues

• Respond to more advanced issue escalations promptly and appropriately; provide managerial approvals as required.

Regulatory and Compliance Management

• Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.

Operational Compliance

• Develop knowledge and understanding of the organization's policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.

Personal Capability Building

• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

Skills

• Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Presenting Solutions

Competencies

• Business Insight
• Collaborates
• Decision Quality
• Drives Results
• Ensures Accountability
• Financial Acumen
• Instills Trust
• Manages Complexity

Education

• NQF Level 5 - Higher, Advance or Occupational Certificate or equivalent