Claims Handler

An exciting opportunity is available with one of our Clients for a Commercial Claims Handler to join their Claims
Department. 

Duties and Responsibilities:
Capturing of all new claim where applicable.
One point of contact for the client/broker and adherence to first call resolution.
Deliver exceptional client service that exceeds customers’ expectations through proactive, innovative
and appropriate claims handling.
Ensures that customer claim is handled efficiently.
Verifies FNOL data or documentation provided to ensure correct settlements of claim
Attend to validation and first call actions on all claims within 1 working hour after registration.
Achieve minimum targets were applicable.
Maintain appropriate diaries and messages on the operating system.
Client input and communication is an integral part at the start of the entire claims value chain, ensuring
that complete and accurate data/documentation is obtained and captured. This determines the direction
of the claim to the entire claims value chain.
Effectively maintains oversight of all relevant claims tasks and manages the claims handling process to
achieve timely settlement and to minimise inaccuracies
Identify, investigate and resolve any issues relating to claims being handled in line with claims policies
and procedures such as SLAs and TAT.
Accurately check/determine whether appropriate cover is in place, interpret policy wordings and
conditions to determine the validity of claims and advises the broker/policyholder accordingly.
Identify potential non-disclosure and misrepresentation cases and follow Insurer''s procedures to deal
with these situations.
Identify any red flags on claims which are potentially fraudulent and follow Insurer procedures for dealing
with these.
 Identify when a specialist is needed to investigate a claim and follow Insurers policies and procedures
for appointing these.
 Identify possible recovery and third-party claims and link the claim to the legal department upon
registration.
Negotiates effectively within agreed mandate limits using an appropriate negotiation style.
Be familiar with the Insurers estimate philosophy and apply accordingly.
Adhere to guidelines for referral of claims to management (e.g. large losses)
Selects and appoints external experts/vendors following Insurer''s procedures and authority levels.
Utilises preferred service suppliers when dispatching service to clients in line with BBEEE targets e.g.
Spend direction tools.
Assist with emergencies and afterhours process for outsourced business.
Minimizes cash settlements vs utilization of preferred suppliers for settlement by managing thepercentage of cash versus quantum.

Qualifications:
Matric is an essential requirement
FAIS Credits (as per FAIS requirement)
Must be Fit & Proper in terms of the FAIS Act
Regulatory Exam: Representatives
Must n