Complex Claims Specialist - Parktown at Hollard Insurance

Role Objectives:

• Process all complex claims assigned, with a focus on all claims above Branch Mandate, within the set 
• standards required by the company thus contributing to the effectiveness and efficiency standards
• of the Team, and the Company at Large. 
• Managing complex claims according to the CCU Project Methodology, mitigating risk, and managing 
• budget, engaging with key stakeholders, and tracking timeline against Claims Framework
• Enhance the image of the company through the continuous delivery of efficient and effective 
• customer service.
• Ensure all technical aspects & specialist functions for claims management and fulfilment are 
• adhered to.

Key Responsibilities:

• Technical expertise: To effectively validate Large Losses against Policy provisions, and general policy 
• conditions and requirements with a view on fair settlement, and simultaneously ensure prevention
• and mitigation of leakage to the company. . Manage claims end- to-end.
• Use knowledge and Skill to evaluate and validate all Complex Claims.
• Stakeholder Management: Maintain a high level of service to all stakeholders identified (internal and 
• external) according to their respective SLA’s.
• Reporting: Provide necessary reporting on financial and operational indicators relating to claims, 
• keep all records and registers up to date. Provide feedback (reporting) to senior management on
• achievements, pending issues, concerns, and suggested recommendations.
• Effective and timeous communication: Communicate in a professional manner with internal and 
• external parties and respond to queries within 24 hours. Keep concerned parties abreast of claims 
• status and development, utilising the Project Management Methodology as represented in the Pack 
• making up a POE (Portfolio of Evidence)
• Estimate Management: to ensure that estimates loaded are accurate, justified by means the 
• necessary supporting documentation, monitored and managed.
• Must have a good understanding of Treaty vs Fac Reinsurance. 
• Risk management: Can spot an adverse risk, to enable suggestions for future risk mitigation. 
• Facilitating monthly triangulate meetings between claims, risk, and underwriting
• Recordkeeping & Reporting: As and when requested.
• Quality control: Quality standards to be adhered to always
• Relationship management: Working with and support the claims teams in the regional offices as well 
• as managing relationships with loss adjustors and specialists. 
• Continuous Process Improvement: Ensure full compliance to all processes, policies and procedures  and identify areas for improvement.
• Variance Management: Adhere to standards set by Hollard. Provide action plans and follow up with corrective actions to all variances.
• Employee Growth: Take responsibility for your own career growth and have regular discussions with  the relevant stakeholders.

Required Knowledge and Experience    

• Good knowledge of specialist risk insurance, with a focus on Commercial Claims
• At least 10 years Claims Experience, of which 5 years should be Commercial Claims. 
• Minimum NQF Level 6
• Good knowledge of specialist risk insurance with at least 5 years Commercial Claims experience 

Educational Requirements    

• Tertiary Qualification from a recognised Institution 
• Re 5 (Fais Exam) will serve as an advantage