Claims Processing
Authorize claims within the set mandate and resolve all claims within the agreed productivity targets and turnaround times by utilizing the claims diary system effectively.
Apply and effectively communicate technical skills and resolve all technical issues using available tools and systems.
Demonstrate a clear understanding and execution of customer complaints and resolutions that must be maintained and exceeded, as well as a clear understanding of claim rejections.
Demonstrate a clear understanding of the management of claims handling that must be followed within the regulated agreements as specified by the relevant regulatory boards.
Ensure a clear understanding of all payments, the correct application of rates to be authorized to the service provider, and the correct appointment of service providers to the claims.
Demonstrate a thorough understanding of the report and quotes to communicate prompt claims resolution to the customer.
Practice and Promote Consistent Effective Relationship Building
Ensure that all Customers are treated fairly, you must have a clear understanding and accurate interpretation of the reported incident, claims history, and correct application of the policy wording.
When communicating technical detail to the Customer, Loss Adjusters to consult or debate the outcome of the claim, ensure lateral thinking and professional engagement with all parties.
Have an inquisitive and investigative mind to communicate and report suspicious activity to the next reporting level if further intervention is required.
Desired Experience & Qualification
Matric
Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5
5 years Short Term Claims Insurance related experience, preferably with Homeowners/Building experience.
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