Claims Negotiator at Ellahi Consulting

Core purpose of the role: 

• To settle third party claims/recover from third parties so as to limit expenses and contribute positively to the profitability of the organisation.

About the organisation:

• Work with driven and focused individuals, in a beautiful and harmonious office environment, 5 kilometers from OR Tambo International Airport 5 days a week.
• Multiple opportunities to exceed KPI’s within SLA.
• Access to dynamic and supportive servant leadership and word class company culture within a young JSE listed company that is a leader in next generation mobility solutions.
• Thrive in a digital workspace, using a web based, world class, omnichannel, single user interface Claims system.

Requirements 

Academic Qualifications

• Matric
• Valid Driver’s license
• Relevant post matric qualification (advantage)

Work Experience

• 2-3 years related experience
• Claims recoveries experience (MVA - Motor Vehicle Accident Claims)
• Apportionments 
• Claims negotiation 
• Uninsured insurance collections 

Knowledge

• Case law, merits, and apportionments
• Vehicle parts, repair quotations and assessments

Role

• Review motor vehicle claims.
• Analyze portfolio of assigned claims daily.
• Prioritize claims by Quantum, Insurance, Merits and Prescription.
• Build, grow and maintain solid and valuable partnerships within the Claims industry.
• Validate supporting documents against digital checklist and upload to DMS where applicable.
• Assess merits per claim, determine degree of liability and finalise claim calculation for Recovery.
• Submit system generated LOD.
• Log sub statuses, third-party consultations, and comments.
• Receive releases, upload to DMS and diarize payment date.
• Proactively bank money within SLA to exceed KPI’s.

Skills

• Computer, technology and systems skills (basic MS Office)
• Well-developed communication skills to negotiate with third parties
• Developed internal resilience (EQ) and interpersonal skills
• Developed written comprehension and reasoning skills
• Developed numerical checking and reasoning skills
• Broad solutioning and problem solving skills
• Spatial reasoning skills

Personal Attributes

• Attentive to detail
• Preference for planning and organising
• Focus on getting things done
• Concern for working within parameters
• Concern for communicating clearly
• Focus on convincing and persuading
• Remain resilient with stress and pressure
• Focus on analyzing and solving problems

Important:

• Preference for thinking practically
• Focus on initiating action
• Appreciation for challenging others with respect
• Preference for team working

Competencies

• Examining information
• Convincing people
• Showing composure
• Meeting timescales
• Checking things
• Following procedures
• Managing tasks

Important:

• Documenting facts
• Interpreting data
• Adopting practical approaches
• Challenging ideas
• Team working

Key deliverables and outputs

• Strategic/Financial

Payment Process

• Request payment from finance department and receive proof of payment within 15 working days.
• Payments received from third parties must be reconciled with the cash book and an allocation request sent to Finance daily (recoveries)
• Ensure that all liability refunds due to customers are requested on a daily basis.
• Operational

Diary planning

• Accept new claims from Claims Administrators at beginning of every day.
• Attend to all files on daily diary and ensure that all overdue files are attended to.
• View and action files daily.
• Update files with progress comments daily on Natural

File preparation

• Determine if all documentation is accounted for, if not requested from Administrator
• Send requisition letter to the third party/draft and send a letter of demand to third party.
• Appoint assessor based on merits of the third-party case (quantum >R10 000)
• Update liability codes as per current status of the case
• Assess file for possible breach and prepare same, then forward to National Damage Admin Supervisor

Settlement

• Assess merits of the case, determine degree of liability and settlement calculations/quantum calculations.
• Prepare settlement proposal.
• Refer all settlement offers received for approval to Claims Manager

Negotiation

• Draft settlement offer and send to third party
• If settlement is accepted by third party, request payment upon signed release.
• If settlement is rejected, negotiate terms and conditions with customer.
• Draft letter of demand based on quantum calculation and negotiate settlement with third party based on merit assessment.

Litigation

• Prepare a litigation file and refer the file to Manager for approval (recoveries)
• Receive and hand over summons to Manager.
• Acknowledge receipt of summons to Attorney
• Determine if all documentation is accounted for in file if none requested from Attorney.
• Obtain authorisation for revised settlement from Claims Manager & Supervisor
• Send revised settlement advise to 3rd party Attorney.
• Receive signed revised settlement advise from third party and request payment upon receipt.
• If rejected, review the cost effectiveness of appointing an Attorney.
• If cost effective, obtain authorisation from Claims Manager & Supervisor to appoint Attorney.
• Hand over file to Attorney
• Follow up on case progress with Attorney monthly

Qualities

• Proactive
• Organized
• Resilient
• Effective
• Efficient
• Exceptional verbal & written communication skills
• Excellent telephone mannerism
• Calm, composed and fast paced individual with focus on exceeding KPI’s within SLA

Reports : Compile report/s monthly and submit on last working day of the month (Range: new and closed files, adjustments, settled cases, cabinet listings)

Stakeholders :(internal & external customers, suppliers, shareholders, communities)

• All correspondence is acknowledged.
• All queries and complaints are actioned.
• Attend all team huddles and meetings as scheduled

 Internal and External Stakeholders

• The role requires close engagement and collaboration with key internal and external stakeholders

Internal Stakeholders

• Finance Team

External Stakeholders

• Attorneys, Third Parties