Claims Consultant - Klerksdorp at Senwes

DUTIES AND RESPONSIBILITIES OF THE JOB:

• Capture relevant claim information in format requested by the insurer(s) for monthly reporting purposes to relevant stakeholder.
• Provide ad hoc reports as requested by insurers from time to time.
• Ensure knowledge of current processes and that processes are followed as instructed.
• Ensure knowledge and usage of current filing systems.
• Ensure validity of system(s) information captured data.
• Distribute received claims
• Identify fast track claims and distribute as per current process
• Request authorization regarding late notifications
• Verification of registered claims
• Insured peril / Peril codes
• Premiums received
• Estimates/Excesses/Limit of cover
• Relevant/necessary documents received

Take action on claim:

• Appoint an assessor
• Give authorization for replacement/repairs
• Determine the value of loss
• Send agreement of loss mail/document for signature of insured to broker/assistant

Repudiations:

• Ensure correct reasons are used when issuing repudiations letters
• Send repudiation letter to insurer for approval and sign off
• Send repudiation letter to broker/assistant and insured

Payments:

• Ensure correctness of invoices received
• Request payments
• Diarize for approval and proof of payment
• Send proof of payment to broker/assistant/service providers

Handling of problematic claims

• Escalate to relevant manager (when necessary)
• Handling of complaints and escalate to relevant manager when necessary
• Identify policies where remedial action should be implemented
• Handling of ex-gratia payments in collaboration with relevant manager
• Escalate possible PI claims to relevant manager

Requirements

• National Senior Certificate (candidates with completed FAIS, RE5 and/or any other insurance related qualification will receive preference)
• Candidates with a certificate in Excel will receive preference
• 3 Years ‘experience in a short-term insurance, claims handling and mediation