Claims Specialist – ADA needed at Bryte Insurance Company Limited

Key Tasks & Accountabilities

• Prioritise daily activities to enable processing and maintenance of all claims.
• Within Mandate
• Check the accuracy of registered claims cover details and add claimant details timeously.
• Confirm estimate is accurate, deducting excess to work out estimate of claim through investigating policy cover.
• Complete fraud list and Identify claims that requires further fraud verification.
• Ensure computer generated letter is forwarded to relevant broker.
• Liaise with stakeholders to gather and ensure accuracy of information.
• If required, inform other relevant departments within claims (e.g. recoveries, salvages, claims verification units etc)
• Capture diary entry immediately after registration process, describing progress and action of claim.
• Deal with and ensure resolution of queries on an on-going basis.
• Obtain necessary documents/assessors report and make amendments to estimates ensuring authorization within policy cover.
• Continually update and maintain diary system.
• Draw payment on relevant system, ensuring accuracy of banking details, invoice number, VAT numbers, class allocation, client release, etc.
• Ensure letters are forwarded to brokers demonstrating breakdown of payments.
• Ensure accurate codes are allocated to payment of claims to minimize leakage.
• Finalize payments on Workflow (Within Mandates)
• Review all open files on a quarterly basis by assessing check reports and claims not processed report (Estimate Review)
• If encounter system problems, log calls timeously with relevant department

Effective customer focus and service

• Liaise with internal stakeholders to facilitate problem resolution and efficiency of work activities.
• Communicate with stakeholders on a daily basis to inform of progress of claims and claim policy and procedure.
• Deal with and resolve any queries relevant to area; if unable to resolve, escalate to manager for resolution
• Represent the organization through maintaining high levels of professionalism, service excellence and customer excellence.
• Adhere to internal policies, processes, and procedures.

Effective adherence to company claims policy, standards, and SLA.

• Ensure adherence to all company policies at all times.
• Ensure adherence to negotiated flexi hours.
• Maintain dress code, behaviour, and absenteeism.

Relationships

Internal Relationship

• All Claims Departments
• Sales
• Underwriting.

External Relationship

• Brokers (Telephonically and Directly)
• Clients
• All Claims Suppliers
• Service Providers

Experience & Qualifications

• Minimum Degree or NQF Level 4
• Minimum 5 years claims handling/ adjustment experience.
• Proven experience in handling of large loss claims, especially cases valued over R1,000,000.00 in Property/ Business Interruption claims.
• Relevant experience of managing service providers, negotiation, and face to face meetings with stake holders.
• Sound knowledge, experience and understanding of short-term insurance.
• General Claims Handling skills
• Understanding of Bryte guiding principles and philosophy and framework
• Applications of claims technical guidelines
• Basic insight into company strategies and business plans
• Clear understanding of Financial Services compliance framework
• Sound knowledge of Bryte organizational structure
• In-depth knowledge and understanding of relevant company policies, processes, and procedures.
• Sound internal network.
• Knowledge of relevant workflow systems