Merit Field Investigator (JG8) needed at Santam Insurance

JOB DESCRIPTION

• The Merit Field Assessor will ensure that all flagged and segmented claims are comprehensively validated to achieve conclusive results.
• The successful incumbent will maintain credibility by ensuring that all validations are conducted in accordance with the Santam Claims Policy and Philosophy and Standard Operating Procedures and appropriate forensic investigation practices.

KEY RESPONSIBILITIES

• Handling of disputes that could arise between Motor merit field and intermediaries and / or claimants.
• Validate and collate information on flagged claims.
• Conduct a field validation on the claim.
• Review the claims documents and photos to validate the claim.
• Handle claim queries within the agreed service levels.
• Handle customers effectively and fairly in line with TCF.
• Finalisation of completed validations within the agreed turnaround times.
• Regular liaison with management and staff at all levels of the company regarding high risk claims escalated/ flagged.
• Consultation with clients, Third parties, Business and Business Partners on a continuous basis regarding fraud and irregularities.
• Regular liaison with counterparts at other insurers.
• Regular liaison with Santam Forensic Services.
• Maintaining relationships with external resources as part collaboration, source of information and investigation purposes.

QUALIFICATIONS AND EXPERIENCE

• Matric/ Grade 12
• Tertiary National Diploma or University Degree would be advantageous
• Short Term Motor Insurance experience 3 years or more
• 2-3 years’ claims experience 
• Understanding of how to handle validations of Motor Claims 
• Previous experience in the Mertis validation of motor claims
• Strong analytical abilities and evaluate trends objectively

SKILLS

• Investigative and good communication skills 
• Administrative and Merit examination
• Excellent customer service skills and proven experience
• Basic Investigation of Claims 
• Insurance knowledge Motor and Quality management
• An inquisitive mind and good questioning skills