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We have an exciting opportunity for the Claims Specialist within SHA Risk Specialists.
What will make you successful in this role?
Key responsibilities:
- Attend and manage all aspects related to a portfolio of specialist claims such as claims registration, case management, drafting, diary, recoveries, and settlement negotiations.
- Draft settlement agreements and other legal documents within mandate as per the Claims Governance Folder.
- Strategically manage a portfolio of claims.
- Manage loss adjusters and attorneys appointment on matters and ensure compliance with agreed service level agreements.
- Monitor and manage legal spend of attorneys and loss adjusters.
- Manage system processing and compliance with systems by way of payments, updating signed off reserves, proper recordal of information etc.
- Attend to Operational duties as allocated.
- Compile and manage risk reports when required.
- Actively manage and record claims above certain thresholds as per The Claims Governance Folder and report on matters to Claims Co and Executive where required.
- Comply with internal and external regulatory framework and internal and external processes and procedures in accordance with organisational standards.
- Draft processes and procedures that are compliant with relevant regulatory framework and applicable legislation.
- Effectively liaise and interact with Underwriters.
Analysis:
- Consider, analyse and interpret insurance policy and the contractual impact thereof for the determination of coverage;
- Critically analyse the facts of the matter and their impact on the underlying policy.
- Draft opinions on the interpretation of coverage in relation to the facts and the applicable policy, present and motivate;
- Draft opinions on merits and quantum of matter with the relevant caselaw and legislation applicable;
- Apply critical thinking to ensure appropriate decisions on merits, quantum and policy response.
- Critically consider and evaluate information provided and identify information required.
- Conduct a strategic assessment of claims and make strategic decisions and recommendations on handling of claims.
- Develop and maintain an understanding of technical and legal aspects impacting on the policy’s operation.
- Make representations and recommendations on improved wording and trends identification to underwriters.
- Be involved in continuous training and development in respect of Case Law, Policy wording, etc.
- Assist in identifying and developing SOP’s and processes to ensure claims department effectiveness.
- Take initiative in creating opportunities of interaction with Brokers and Insureds.
Client Liaison (Internal and External):
- Liaise with clients to resolve queries to the satisfaction of the affected parties within the scope of authority and / or responsibility.
- Prepare for and attend meetings and consultation with brokers, insureds, legal representatives and loss adjusters.
Skills and Competencies
- Administrative Skills
- Analysis and Judgement
- Attention to Detail
- Client Orientation
- Communication Skills including negotiation
- Follow Up
- Initiative
- Interpersonal Skills
- Organisational Awareness
- Planning and Organising
- Teamwork
- Computer Literacy
- Ability to strategise and drive a claim to finality
Qualifications & Experience
- Matric
- Law Degree
- Admitted attorney
- FAIS compliance a preference
- Previous non-motor liability claims handling experience
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