Claims Specialist at Santam Insurance

Key responsibilities:

Claims Practice Management:

• Attend and manage all aspects related to a portfolio of specialist claims such as claims registration, case management, drafting, diary, recoveries, and settlement negotiations.
• Draft settlement agreements and other legal documents within mandate as per the Claims Governance Folder.
• Strategically manage a portfolio of claims.
• Manage loss adjusters and attorneys appointment on matters and ensure compliance with agreed service level agreements.
• Monitor and manage legal spend of attorneys and loss adjusters.
• Manage system processing and compliance with systems by way of payments, updating signed off reserves, proper recordal of information etc.
• Attend to Operational duties as allocated 
• Compile and manage risk reports when required
• Actively manage and record claims above certain thresholds as per The Claims Governance Folder and report on matters to Claims Co and Executive where required.
• Comply with internal and external regulatory framework and internal and external processes and procedures in accordance with organisational standards.
• Draft processes and procedures that are compliant with relevant regulatory framework and applicable legislation. 
• Effectively liaise and interact with Underwriters. 

Analysis:

• Consider, analyse and interpret insurance policy and the contractual impact thereof for the determination of coverage;
• Critically analyse the facts of the matter and their impact on the underlying policy.
• Draft opinions on the interpretation of coverage in relation to the facts and the applicable policy, present and motivate;
• Draft opinions on merits and quantum of matter with the relevant caselaw and legislation applicable;
• Apply critical thinking to ensure appropriate decisions on merits, quantum and policy response.
• Critically consider and evaluate information provided and identify information required.
• Conduct a strategic assessment of claims and make strategic decisions and recommendations on handling of claims.
• Develop and maintain an understanding of technical and legal aspects impacting on the policy’s operation.
• Make representations and recommendations on improved wording and trends identification to underwriters

Individual Claims Leadership:

• Be involved in continuous training and development in respect of Case Law, Policy wording, etc. 
• Assist in identifying and developing SOP’s and processes to ensure claims department effectiveness.
• Take initiative in creating opportunities of interaction with Brokers and Insureds. 

Client Liaison (Internal and External):

• Liaise with clients to resolve queries to the satisfaction of the affected parties within the scope of authority and / or responsibility.
• Prepare for and attend meetings and consultation with brokers, insureds, legal representatives and loss adjusters.

Skills and Competencies

• Administrative Skills 
• Analysis and Judgement 
• Attention to Detail 
• Client Orientation 
• Communication Skills including negotiation 
• Follow Up 
• Initiative 
• Interpersonal Skills 
• Organisational Awareness 
• Planning and Organising 
• Teamwork 
• Computer Literacy
• Ability to strategise and drive a claim to finality  

Qualifications & Experience

• Matric 
• Law Degree 
• Admitted attorney 
• FAIS compliance a preference 
• Previous non-motor liability claimshandling experience