Claims Processing Consultant

Claims Processing Consultant

Cape Town, Western Cape

Woodstock, Western Cape - R120,000 - R360,000

Y Lewis group

Posted today

Job Description

Requirements :

Grade 12

Clear criminal and credit record.

Knowledge of microinsurance claims and complaints regulations.

Knowledge of Treating Customers Fairly principles.

Additional South African Languages.

Knowledge of Lewis Stores processes and procedures.

Ideal Experience :

• 3 years+ experience in a managerial position (incl. assistant management position)
• Claims and Complaints handling.
• Computer literate in MS Office (Word, Outlook and Excel)
• Proficient communication skills verbally and written
• Able to manage a team effectively
• Self‑motivated, committed and a driver of performance
• Disciplined in meeting deadlines and agreed targets

Responsibilities :

Insurance claims – MANAGE CLAIMS ASSESSMENT team, REVIEW ASSESSMENT, assist & REPORT :

• Reporting into the Insurance Claims Manager.
• A team of Customer Protection Insurance claims clerks will report into you.
• Review and approve the assessment of authorised, declined or queried Customer Protection Insurance claims.
• Monitor daily claims reports and assist claims clerks to resolve difficult claims that are not being finalised.
• Ensure that the 48‑hour SLA report and Pending Preview report is cleared daily by the claims team.
• Ensure that the Pending Complete report is followed‑up and cleared daily and where required follow‑up with Lewis Stores Branch Accounts regarding outstanding journals.
• Ensure that the Stock Replacement report is followed‑up daily and escalates goods replacements with Lewis Stores senior management where required.
• Monitor the Claims Indexing clerk's workload through the incoming claims mailbox and Papertrail indexing queue and ensure that emails and incoming documents are cleared daily.
• Manage and guide the claims clerks daily to finalise claim assessments efficiently when dealing with queries, follow‑up, goods replacements etc. as the claims team works with customers lodging a claim, branch operational staff, and / or head office branch accounts.
• Monitor claims follow‑up processing ensuring approved processes and procedures are followed.
• Ensure that claim escalations or disputes are referred to Monarch senior management in a timely manner.
• Prepare and attend daily / weekly claims meetings with your claims team and management.
• Monitor claims team in line with the criteria documented in the monthly / quarterly staff incentive letters.
• Assist senior management with queries and / or follow‑up requests from the insurance regulator (PA / FSCA), the National Finance Ombuds Scheme, South African Insurance Association (SAIA), South African Special Risks Insurance Association (SASRIA) etc.
• Assist with providing information on claims queries received from e.g. the Lewis Stores finance department, Lewis Stores Internal Audit department or management.

STAFF MANAGEMENT – CLAIMS

• Monitor daily attendance and report to Insurance Claims Manager incorrect clock‑ins where required.
• Monitor and request overtime and leave requests with the Insurance Claims Manager.
• Assist the Insurance Claims Manager to conduct interviews for claim clerk vacancies when necessary.
• Attend to daily staffing needs and queries.
• Assist with further developments / improvements where necessary.
• Identify areas of training needs.

Job Type : Full‑time

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