Claims Consultant

JOB PURPOSE

Process already-captured claims efficiently and accurately through drawing on the relevant criteria to ensure standardisation across the organisation to enable decision making on a claim.

Responsibilities

Customer Management (Internal)

Help manage customer by carrying out standard activities to complete the customer request.

Data Collection & Analysis

Ask questions, collect data from a variety of sources, analyse information and investigate claim.

Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims.

Use appropriate tools to accurately cost applicable claims on a day-to-day basis.

Work Scheduling and operational compliance

Organise own work schedule to get the job done, coordinating with support services and completed work within SLA.

Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately).

Remain up to date with current and new product knowledge to enable effective decision making.

Administration

Produce, update and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.

Correspondence

Respond to routine requests using telephonic conversation or emails (internal and external).

Document Management

Create, organise and maintain files containing the correspondence relating to policies and matters.

Document Preparation

Prepare and manage claim documentation for customers.

Prepare insurance claim forms or related documents and review them for completeness.

Enter claims information into database systems.

Pay small claims.

Calculate quantum amount of claim.

Post or attach information to claim file.

Transmit claims for further investigation.

Contact insured or other involved persons to obtain missing information.

Review insurance policy to determine coverage.

Organise or work with detailed office records, using computers to enter, access, search or retrieve data.

Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.

Finalise claims and communicate the outcome to the customer

Listen and transcribe client conversations

Request Client Conversation

Retrieve Client Conversation

Issue repair / replace vouchers

Load and action 15-minute messages

Complete Things to Do (TTD's) and requests

Refer to Loss Adjuster when required

Arrange to collect salvage - non-Motor where applicable

Arrange to collect salvage - Motor where applicable

TECHNICAL COMPETENCIES

Customer Focus

Builds strong customer relationships and delivers customer-centric solutions.

Decision Quality

Makes good and timely decisions that keep the organization moving forward.

Manages Complexity

Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems

Drives Results

Consistently achieves results, even under tough circumstances.

Being Resilient

Rebounds from setbacks and adversity when facing difficult situations.

Manages Conflict

Handles conflict situations effectively, with a minimum of noise.

Communicates Effectively

Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences.

Ensures Accountability

Holds self and others accountable to meet commitments.

Plans and Aligns

Plans and prioritizes work to meet commitments aligned with organizational goals.

General Education

Matric / Grade 12/ SAQA Accredited Equivalent (Essential)

General Experience

1 or more years' Financial Services industry experience (Essential)

Call Centre Experience (Essential)

STI experience (Advantageous)

1 or more years' Claims Experience (Advantageous)

At least 2-3 years experience in a Customer Service environment (Advantageous)

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