Claims Consultant Durban

Future Careers • Other • Durban, KwaZulu-Natal, South Africa • $300 - $400 / year • 7h ago

Claims Processing

The following directly centers around which your daily obligations revolve:

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.
Have a clear understanding of how to operate a claims management system, as well as the use of relevant tools that can enable the quick resolution of a claim and ensure effective communication, such as using Outlook to send emails, SMS via grapevine, and exporting own reports to Excel.
Have a working knowledge of the internet and how to use Google Maps.

Plan, Communicate, Solve Problems, And Carry Out Decisions Effectively.

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.
Possess the ability to communicate calmly and professionally yet assertively with difficult customers at all levels and outcomes in a fair, sensitive, and persuasive manner, always keeping in mind that the customer must be treated fairly as required.
Have a clear understanding of how to engage and communicate with the appropriate specialist service providers to engage on each claim, such as engineers, etc.

This includes but is not limited to:

Internal Daily relationships with:

Finance Division to improve on service delivery issues regarding payment authorizations.
Policy Administration for advice of any policy amendments, client queries/requests, and complaints resolution.
Insurance Customer Contact Centre to provide and assist with advice on any noted anomalies or trends that could affect the processing of new claims and identify risks associated if any.
Management and peers to provide daily interactions about any contentious matters and or report on urgent claims that require attention or authorization.
Procurement Manager, to ensure that service providers strictly adhere to the current service level agreement.
Claims Fulfillment Manager, to guide, assist, mentor and advice you of all matters that can assist you with your growth.
Operations Manager, to guide, assist and advice you through your first line report, in line with your growth and any other communication in terms of your claims.

External Daily relationships with:

Provide exceptional customer experience throughout the customer journey and assist by providing professional peace of mind while dealing with queries or providing feedback proactively.
Panel or non-panel service providers; relationships ensure professional customer service interaction, with loss adjusters, quantity surveyors, forensics experts, etc. and various specialists required to complete the successful claim.
Internal and external auditors to provide assistance during interim or final company audits.

Values and Self-Development

It is critical that pride in the company's mission, vision, and values be taken seriously.
It is critical that you take charge of your own personal development and career path.
You must follow and adhere to the company's code of ethics; doing so improves the reputation and brand of yourself, your department, and your company.
You must comply with and adhere to the organization's and regulatory boards' regulations and legislation.
You must understand, support, and live the organization's Amazing Service Culture.
You are to carry out fair and reasonable instructions that are given to you within the prescribed turnaround time, whether written or verbal, as noted in the operational manual, regulatory boards, operating procedures, and processes, to ensure that we achieve only the best outcome for and in the interest of the customer and the business.