Insurance Technical Claims Specialist at Guardrisk

The main functions: 

This role is responsible for the:  

• Review and monitoring of large loss claims from Underwriting Management Agencies and Non Mandated Intermediaries;
• Provide general claims handling guidance to external/internal stakeholders/(cell captive owners) including liability claims ; 
• Identify claim trends across multiple stakeholders and escalating to portfolio managers;
• Attending to Ombudsman for Short Term Insurance matters;
• Provide technical claim expertise to stakeholders where required
• 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 assigned portfolios and providing assistance and guidance to stakeholder on corrective actions.
• Review and approval of non-mandated intermediary rejections; 
• Review of litigation matters;
• Attend to representations following claim rejections; 
• Technical review ofl claim disputes; 
• Attend to meetings with stakeholders/cell captive owners and portfolio managers in relations to claims; 
• Preparing monthly report ; 
• Identify gaps in policy wordings from the claims experience and making recommendations to business ;
• Ensuring the application and compliance of TCF outcomes and regulatory Industry legislation compliance in the claims, complaints handling and processes;
• Ex-gratia claim approval

Knowledge and Skills

• Matric /Grade 12
• Higher Certificate in insurance(preferable)
• LLB Degree

Experience

• Minimum 5 years experience within Short Term Industry
• Previous Short Term Claims Experience  

Knowledge, Skills and Abilities 

• Sound Insurance knowledge (Personal Lines & Commercial)
• Knowledge of Industry claim practices and procedures
• Claims technical knowledge and application thereof
• Understanding of OSTI framework and the application thereof in complaints handling