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Claims Handler : Short Term Insurance

Claims Handler : Short Term Insurance

HR GenieJohannesburg, South Africa
30+ days ago
Job description

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.
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    Short Term Insurance • Johannesburg, South Africa