Claims Consultant at Hollard Insurance

Job Purpose

• To ensure that all risk claims are accurately assessed by applying agreed principles which are aligned to Insurance Industry standards
• To ensure that our customers are treated with dignity as per the purpose statement and our service is aligned to Industry best practices.
• Managing the Hollard’s risk by ensuring that valid claims are paid and invalid claims are not paid. Ensuring the correct claims are paid to the correct parties.
• Managing our risk by verifying the information at sales, administration and claims stage and reporting operational risks to Compliance.
• Comply with all Acts pertaining to 
• Participate in the Dispute review committee for Business and TCF decisions.

Key Responsibilities:

• Full and accurate assessment of all life cover, disability, retrenchment, hospital, credit life and funeral claims required in terms of life claims principles & philosophies. Ensure all requirements have been received and that systems have been updated and that the correct value has been calculated.
• Application and interpretation of policy terms and conditions to assess claims correctly.
• Authorisation of claims within agreed mandate
• Verify, identify fraud and invalid claims.
• Ensure that required documentation for  FICA  is received and verified
• Identifying operational risk from sales , administration and claims and reporting it  to the manager.
• Ensure that queries are resolved timeously and correctly.
• Ensure daily targets are achieved and quality scores are above 95% each month.

Outputs

• Full and accurate assessment of all claims required in terms of life claims principles & philosophies.
• Ensure all requirements have been received; Standard Operating Procedures applied and the correct value has been calculated.
• Application and interpretation of policy terms and conditions.
• Authorisation of valid claims within agreed mandate on line of business system.
• Maintaining clear and consistent communication with internal & external parties regarding pending claims and requirements thereof
• Liaising with internal investigation team on claims where further assistance is required
• Ensuring that all line of business systems are updated and that all necessary notes have been made on the relevant systems
• Maintaining professional telephonic and written communication with customers and internal stakeholders.
• Ensuring that final assessed claims are timeously submitted for payment/repudiation after a decision has been entered on the claims system
• Compilation of daily stats to Team leader
• Maintaining turnaround times in terms of Service Level agreements and meeting team KPI’s

Required Knowledge and Experience

• Industry and compliance knowledge
• Life Insurance product knowledge: various policy wordings, business rules etc.
• Operational knowledge of relevant official authorities
• 2 – 3 years Life Insurance claims experience

Skills

• Accountable and reliable
• Attention to detail
• Deadline driven
• Service orientation
• Able to work independently and to take initiative but  work as part of  a team
• Good numeric skills
• Communication skills (written and verbal)
• Interpersonal skills
• Problem solving/lateral thinking
• Ability to work under pressure and resilience
• Excellent planning/organizational skills

Educational Requirements

• Matric a prerequisite
• Post matric studies/qualification in the medical field an advantage.
• COP or similar an advantage