Claims Technical Specialist at Guardrisk

Role Purpose    
Effective management of Stakeholders claim portfolio’s , with the objective of mitigating risk within the claims environment  by ensuring correct application of standard claim processes and procedures  and the implementation of compliance with regards to regulatory industry legislation within the claims segment of the organization. 

Requirements    

• Matric 
• Relevant Insurance Experience (Overall Insurance knowledge)
• LLB Advantageous
• Certificate in Insurance Advantageous (NQF 5)
• Minimum 5 years in a technical claims environment 
• Previous Short Term Claims Experience in a senior role

Duties & Responsibilities    

• Review and monitoring of large loss claims from UMA’s and NMI’s;
• Provide general claims handling guidance to external stakeholders including liability claims ;
• Identify claim trends across multiple stakeholders and escalating to portfolio managers/ Market Conduct;
• Attending to OSTI matters;
• Provide technical claim expertise to stakeholders where required;
• Attend to Ad-Hoc tasks that may be assigned from time to time;
• Attend to client reviews with specific focus on claims handling processes/suppliers management/operational risks and adherence to SLA’s between Guardrisk and other related third parties; ensuring risk management of portfolio is attended to,
• Monitoring of loss ratio’s across all portfolios under your management and providing assistance and guidance to stakeholder on corrective steps to be actioned if loss ratio not favourable
• Review and approval of non-mandated intermediary rejections;
• Ensure that rejections/complaints/rejection representations recorded on the Respond system;
• Attend to litigation matters;
• Attend to representations following claim rejections;
• Attend to general claim complaints;
• Attend claim/operational meetings with stakeholders and portfolio managers;
• Preparing and attending to monthly report as assigned ;
• Identify gaps in policy wordings and making recommendations for changes where necessary;
• Ensuring the application and compliance of TCF outcomes and regulatory Industry legislation compliance in the claims, complaints handling and processes
• Ex-gratia claim approval
• Handling of SASRIA claims
• Managing stakeholder relationships – internal and external

Competencies    

• Analytical thinking
• Negotiation skills
• Customer Orientation
• Building Relationship
• Influencing
• Time management
• Self –motivated
• Disciplined

Closing Date: 18th, August 2022