The main purpose of the Claims Specialist’s role is to validate and process short-term insurance claims following a fortuitous event. Working in close partnership with an allocated portfolio of brokers, the Binder and Outsource Claims Specialist will specifically make claims validation decisions on complex and high value claims that exceed the broker’s mandate (for both Motor and Non-Motor, Personal Lines and Commercial Lines).
The Claims specialist will also fulfill a coaching role, assisting and guiding binder and outsource brokers to make correct claims validation determinations on all claims that fall within their defined mandate.
The Claims Specialist will oversee the training and oversight of the binder and outsource brokers
Key Performance Areas: - Validation of claims in line with Company guidelines and Standard Operating Procedures
- Management of Large loss and complex claims
- Appointment of necessary providers
- Authorizations\Settlement of claims
- Rejection of claims
- Processing payments within the turn-around time
- Payment confirmations to Brokers and Suppliers
- Assisting clients and brokers over the phone / email with claims and queries
- Relationship Management with allocated brokers, including training of brokers with binder and outsource
agreements - Oversight and management of binder and outsource brokers
- Complaints handling and resolution
- Liaising with Service Providers
- Liaising with brokers and clients
Requirements: - Matric Certificate – essential
- Regulatory Exam
- Further Education and Training Certificate in Short-Term Insurance – NQF 4, and/ or a Higher Certificate in
Short term Insurance - NQF 5 - Class of Business certification (Personal Lines & Commercial Lines) – Highly advantageous
- Must be compliant with FAIS Fit and Proper requirements with track-record of working unsupervised.
- Marine and Engineering knowledge – Highly advantageous
- Computer literate – Microsoft Word, Excel, and Outlook
- Experience in Commercial and Personal lines
- At least 5-10 years’ relevant work experience in claims validations and settlement (both in Motor and NonMotor claims, as well as in both Personal Lines and Commercial Lines classes of business)
- Work experience within a licensed insurer, or Underwriting Manager.
- Experienced in making claims settlement determinations with mandate exceeding R250 000.00
- Sound technical knowledge and understanding of relevant short term insurance policy wording
Please note that only shortlisted candidates will be contacted 
