Pretoria: Claims Handler: Short Term Insurance posted by CompitantCandidates

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.