Position Overview
The Claims handler must maintain relationships with clients to ensure retention of business and facilitate new business. An extensive knowledge of products and providers is necessary. The Claims handler is responsible for complete and accurate administration related to all claims and clients.
Mission, Values and service Strategy
- To Uphold and support the company mission, service strategy and values of client service, professionalism, performance, innovation and partnership.
- Perform all other reasonable functions as required by the business.
- To always act within the scope of your mandate provided by the FSP.
- Report any suspected fraud, misrepresentation and/or dishonesty.
Performance Management
- KPI’s set for balance scorecard in conjunction with reporting manager.
- Performance appraisals prepared for as required.
Self-Development
- Achieves and maintains FAIS requirements for the position.
- Keeps abreast of developments for the position.
- Continually work towards further self-development.
- Remain up to date with product and industry related knowledge to enable effective decision making.
- Ensure all fit and proper requirements including honesty and integrity, competency and operational ability requirements as set out by prevailing legislation.
- Deliver on TCF (Treating Customers Fairly) principles in alignment with regulatory requirements.
Relationships
- Regular feedback to customers and other stakeholders, as outlined in the agreed service level agreements to ensure customers receive appropriate levels of service delivery.
- Attend and contribute to team and individual meetings.
- Maintaining effective relationships with all internal and external parties on a day to day basis.
- Develop relationships with clients and ensure consistent high level of service delivery.
Administration
- Perform all tasks as detailed in the Service level Agreement.
- To receive and finalise instructions from clients, brokers and all other stakeholders.
- Capture and update all tasks onto the task management system.
- All required documentation to be collated and saved to the respective record keeping repository.
- Checking all documentation and correspondence to ensure correctness before processing.
- Maintain a quality assurance process that identifies and corrects shortcomings..
- Adhere to all internal and external processes, guidelines, mandates and service level agreements.
- Compile and generate reports where required by management.
- Accurate and effective administration of claims.
- Use appropriate tools to accurately cost claims on a day to day basis.
- Review and ensure application of the policy terms and conditions against each settled and repudiated claim.
- Inform client and underwriters of items that are to be deleted from cover once the claim is settled.
- Refer all advice related enquiries to sales or Underwriting.
- Necessary telephonic and email follow ups to ensure that client is aware of claims status.
- General office support and administration as required.
- It is of utmost importance that annual CPD hours are achieved and all regulations set by the FSCA such as (but not limited to) POPIA and Fit & Proper requirements are adhered to at all times.
Product Knowledge
- Interpret and process technical short term insurance related information.
- Extensive knowledge of all classes of insurance offered to clients and related products maintained.
- Insurer knowledge in respect of products offered is maintained.
- Ideas proposed for new products.
- Competitor information gathered and communicated.
Core Competencies
- Excellent communication and interaction skills.
- Attention to detail.
- High level of administration skills (filing/record keeping).
- Ability to analyse and make decisions.
- Sound knowledge of insurance products and insurers.
- Knowledge of the insurance industry in general.
