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Claims Technician

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7 months ago295 views

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General Details

Location:

Johannesburg CBD, Johannesburg

Advertised By:Agency

Company Name:Empire Recruitment

Job Type:Full-Time

Description

Our client is looking for a confident Claims Tech who is able to function well under pressure. The role requires the skills and experience stated below:

Qualifications and Experience:

To ensure the accurate capturing, processing and finalisation of all Commercial Claims
Successfully passed RE 1
Minimum five years relevant work experience in short term insurance claim settlement (Commercial claims, Motor and Non-Motor). Motor Agg’s / Co-insurers / XOL Insurance / Assets based policies.

https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8yMzEzMzQxMDI0P3NvdXJjZT1ndW10cmVl&jid=1691757&xid=2313341024

Id Subtitle 1235049924

Empire Recruitment

Selling for 2+ years

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Identify fraud trends and continuously develop process improvements and mitigation controls to support the Group Business. Proactively engage with key stakeholders both internally and externally to gather intelligence and create and develop relationships with key organisations. Responsibilities of the Role: Successfully lead a team of Investigation Officers by providing quality regulatory technical expertise, case direction and excellent operational management to ensure assurance procedures, file and document reviews etc.Maintains an overview of all cases within the team to provide expert technical guidance and case direction and ensure the work is always of high quality and that there is a consistent, timely approach taken with each case.Responsible and accountable for high-quality and timely case progression within the team.Provides regular case updates/reviews to senior managers and key stakeholders, especially in relation to high profile and sensitive matters.Positively and proactively contributes as part of the Investigation leadership team in implementing changes and improvements as appropriate.Ensure that reports and documentation are produced to the highest standards, which will stand up to the scrutiny of the Section 91 Tribunal and Courts - supporting and coaching Investigation Officers as required.Effectively manage and motivates the team/individuals by providing clear communication, robustly managing performance/providing timely constructive feedback (regular reviews) and supporting/coaching individuals to improve and fully engage in their own development and learning.Work collaboratively across the organization and demonstrate a positive and proactive approach to achieving organisational objectives, including providing expertise and taking responsibility for leading on projects and priorities.Investigations are outcomes-focussed, timely and a risk-based approach is developed and executed for each investigationInterpret policy and decisions to stakeholders for effective communicationRepresent the company at various forums and interact with other stakeholdersIdentify and report falsified claims to the Legal Operations for recovery purposesIdentify fraud trends by analysing data and industry alertsIdentify suspicious activity and work with appropriate teams to investigate and thwart the activityProvide statistical data on losses on a regular basisDevelop processes and procedures to prevent or minimise claims fraud lossesEnsure Service Level Agreement and turnaround times of external serviceproviders and internal investigators are adhered to Identify key risk indicators and establish mitigating controlsEnsure that expenditure is incurred within the limits of the sanctioned budgetEnsure that new r... https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8yOTYyMDc0MzMxP3NvdXJjZT1ndW10cmVl&jid=1422200&xid=2962074331

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CAREER OPPORTUNITYAn exciting opportunity exists for a Commercial Team Manager to join the Claims Department. This position is based in Centurion. JOB DESCRIPTIONDuties and Responsibilities:• Deliver exceptional client service that exceeds customers’ expectations through proactive, innovative, and appropriate claims handling.• Handling of performance related issues and disciplinary matters.• Manage, support and developing a team of people to ensure service delivery and performance management applied consistently.• Manage people related matters i.e., attendance, absence, and attrition (staff turnover) within the team to ensure service level contributions are met or exceeded.• Weekly team meetings, participation on one-on-one discussion and other meetings required from time to time.• Demonstrates an effective communication style, that motivates, across internal and external teams and individuals that may become involved with claim tasks.• Identify, investigate, and resolve any challenges relating to claims being handled in line with claims policies and procedures such as SLAs and TAT.• Meeting of set deadlines.• Managing team’s task adherence (diary, message, and email management)• Monitoring immediate first call resolution within the claims department.• Management of outstanding claims monthly. (Outstanding listings)• Authorise and validate claims that does not fall in the staff mandate.• Ensure compliance in terms of Under Supervision and record keeping.• Liaising, build excellent relationships and ensure accurate and timeous response to brokers and clients on queries.• Monitor effective use of approved suppliers and adherence to contracted rates to improve loss ratios.• Auditing of claims within your team monthly• Monitor equal distribution of claims.• Analyse training needs: identify possible problem areas and change weakness into strength.• Provide supporting reports and information to Claims Portfolio Manager to compile feedback to Executive Head• Ensuring client satisfaction improvement: QA processes/CSI scores/Complaints Root Cause Analysis.• Provide policy wording interpretation.• Courteous and professional attendance to telephonic queries.• Deliver strategic results in term of the Vision and Mission.• Align own behaviour with the organisation culture and values.• Demonstrate commitment toward the team and participate in building team culture.• Collaborate and work closely with all role-players thereby leveraging constructive team dynamics and innovation.• Identify and recommend enhancements to processes.• Monitoring of call pause procedures and availability within the department together with managing the contact centre.• Proactively ensure the most effective use of time, resources, money, materials, or equipment in line with policies and pr... https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS85OTY2NTQ4Mjg/c291cmNlPWd1bXRyZWU=&jid=1749150&xid=996654828

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Role Purpose Implement the compliance strategy aligned to the compliance monitoring plan to assist the business in honoring their responsibility to comply with applicable regulatory requirements through directing the compliance function through identification, assessing, managing, monitoring and report on regulatory compliance risks facing the organisation. The position shall further provide assurance that company policies and procedures are being complied with and that the organisation meets the regulatory and companys own standards and ensure that compliance support is aligned to business strategy. Responsibilities and work outputs Implement and manage an effective compliance program through the development and management of risk and compliance plans.Develop and review company policies including effective implementation of policies and guidelinesAdvise management on the company’s compliance with laws and regulations through detailed reports.Create and manage effective action plans in response to audit discoveries and compliance violations.Regularly audit company procedures, practices, and documents to identify possible weaknesses or risks.Tracking and monitoring of key risk indicators, controls and action plans.Assess company operations to determine compliance risk.Conduct research on compliance related topicsDevelop training materials and assist with training to ensure all employees are educated on the latest regulations and processes.Assist in compiling risk and compliance reportsCollaborate with other leaders on cross-functional initiatives that focus on the mitigation of compliance risks.Work with external partners such as Internal Audit to endure the effectiveness of the compliance functionAssist in innovate the Compliance program and function and identify improvements to existing processes and plans.Provide guidance to business and assist with implementation of compliance policies and projects.Drafting and compiling regulatory submissions. Competencies Excellent organisational and administrative skillsExcellent communication skills (verbal and written)Report writing skillsAccountable, takes Ownership and ResponsibilityAttention to detailNegotiation skills and Problem-solving abilityStrong People skillsAbility to work independently and in a team environmentAnalytical thinker with investigative instinctSelf-disciplined and self-motivatedStress Tolerance, tenacity and ResilienceProfessional approachAssertive and tactful with the ability to handle conflictResults driven https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8xMzUwNjA1NzY5P3NvdXJjZT1ndW10cmVl&jid=1512319&xid=1350605769

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