Job Description
Job Purpose
We pride ourselves on our superior customer experience for all our customers, whether internal or external, by applying the highest technical claims knowledge and systems understanding when resolving claims and providing support within the company. Our area of expertise consists of building claims. The inherent goal is to consistently exceed customer expectations as governed by regulations and to drive timely settlement of claims while applying risk management principles at a consultant level.
Claims Processing
The following directly centers around your daily obligations:
- 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.
- 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 reports 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 quick resolution of a claim and ensure effective communication, such as using Outlook to send emails, SMS via grapevine, and exporting 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, 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, always keeping in mind that the customer must be treated fairly.
Practice and Promote Consistent Effective Relationship Building
Maintain effective relations with all stakeholders within the organization. This includes but is not limited to:
Internal
Daily relationships with:
- Finance Division to improve service delivery issues regarding payment authorizations.
- Companies Contact Centre to assist and improve customer communication, complaints, and technical support.
- Policy Administration for advice on any policy amendments, client queries/requests, and complaints resolution.
- Management and peers to provide daily interactions about any contentious matters and 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 advise on all matters that can assist with your growth.
- Operations Manager to guide, assist, and advise you through your first line report, in line with your growth.
External
Daily relationships with:
- Company Customer: provide exceptional customer experience throughout the customer journey.
- Panel or non-panel service providers; relationships ensure professional customer service interaction.
- Companies' representatives to provide assistance and resolve customer issues.
- Internal and external auditors to provide assistance during audits.
Values and Self-Development
It is critical that pride in the company's mission, vision, and values be taken seriously. You must take charge of your own personal development and career path. You must comply with and adhere to the organization's and regulatory boards' regulations and legislation.
Profile
- The candidate should respond on technical aspects of the policy and be able to translate from reports and respond accurately to customers.
- Matric.
Preferred Qualification:
- Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5.
- 4 years Claims experience, preferably Homeowners/Building Claims experience.
- 5 years Short Term Claims Insurance related experience, preferably with Homeowners/Building experience.
Competencies
Must have technical and problem-solving skills, combined with strong claims judgement and ability to communicate in a clear and compelling manner.
- Strong verbal and written communication ability.
- Handle pressure and be willing to work overtime. Shift work is compulsory.
- Persuasive, loyal, accurate, decisive, assertive, confident, fair, ethical, high integrity, reliable, responsible.
- Initiative, team player, respect for others.
- Building/Homeowners Claims and Customer Service orientated.
- Computer literate, Excel, Word, Microsoft Outlook.
- Claims Management and effective ability to navigate systems.
- Understand and communicate technical matters analytically.
- Have excellent verbal and written communication skills.
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