Pretoria: Claims Handler: Short Term Insurance

Our client requires a Claims Handler. Your: Formal Education: Matric RE 5 Examination Level 1 Class of Business: Commercial and Personal Lines NQF 5 in short term insurance Experience: At least 5 years short term experience and 4 within the claims environment. will enable you to do the following duties: Claims Registration and Acknowledgement: Receive, review, and register new claims via phone, email, or digital channels. Acknowledge receipt of claims to clients within stipulated turnaround times. Initial Assessment and Documentation: Collect all necessary documentation from clients to substantiate claims (e.g., claim forms, supporting evidence, police reports, photographs, invoices). Assess policy coverage, terms, and conditions for each claim. Request additional information from clients or third parties when required. Investigation and Evaluation: Conduct investigations through interviews, site visits, and consultation with service providers or loss adjusters. Verify the legitimacy and validity of claims. Apply technical knowledge to interpret policy wordings and determine liability. Claims Processing and Settlement: Calculate and agree settlement amounts in line with policy terms, ensuring fairness and compliance. Negotiate settlements with clients, service providers, and, where necessary, legal representatives. Authorise and process payments within designated authority limits. Customer Service and Communication: Maintain regular communication with clients throughout the claims process, providing updates and managing expectations. Respond to queries, complaints, and escalations in a timely and professional manner. Deliver empathetic service during potentially stressful situations for clients. Fraud Detection and Prevention: Identify potential fraudulent activity and escalate cases in line with company procedures. Work closely with internal audit and fraud prevention teams as required. Reporting and Documentation: Maintain accurate records and documentation for all claims handled. Prepare and submit reports for management, compliance, and regulatory purposes. Continuous Improvement and Compliance: Stay informed of changes to insurance legislation, industry trends, and best practices. Participate in training and development opportunities to enhance skills and knowledge. Adhere to company policies, procedures, and ethical standards at all times.