Description:
Duties and Responsibilities:
• Capturing of all new claim where applicable.
• One point of contact for the client/broker and adherence to first call resolution.
• Deliver exceptional client service that exceeds customers’ expectations through proactive,
innovative and appropriate claims handling.
• Ensures that customer claim is handled efficiently.
• Verifies FNOL data or documentation provided to ensure correct settlements of claim
• Attend to validation and first call actions on all claims within 1 working hour after registration.
• Achieve minimum targets were applicable.
• Maintain appropriate diaries and messages on the operating system.
• Client input and communication is an integral part at the start of the entire claims value chain,
ensuring that complete and accurate data/documentation is obtained and captured. This
determines the direction of the claim to the entire claims value chain.
• Effectively maintains oversight of all relevant claims tasks and manages the claims handling
process to achieve timely settlement and to minimise inaccuracies
• Identify, investigate and resolve any issues relating to claims being handled in line with claims
policies and procedures such as SLAs and TAT.
• Accurately check/determine whether appropriate cover is in place, interpret policy wordings
and conditions to determine the validity of claims and advises the broker/policyholder
accordingly.
• Identify potential non-disclosure and misrepresentation cases and follow Insurer's procedures
to deal with these situations.
• Identify any red flags on claims which are potentially fraudulent and follow Insurer procedures
for dealing with these.
• Identify when a specialist is needed to investigate a claim and follow Insurers policies and
procedures for appointing these.
• Identify possible recovery and third-party claims and link the claim to the legal department
upon registration.
• Negotiates effectively within agreed mandate limits using an appropriate negotiation style.
• Be familiar with the Insurers estimate philosophy and apply accordingly.
• Adhere to Brolink' s guidelines for referral of claims to management (e.g., large losses)
• Selects and appoints external experts/vendors following Insurer's procedures and authority
levels.
• Utilises preferred service suppliers when dispatching service to clients in line with BBEEE
targets e.g., Spend direction tools.
• Assist with emergencies and afterhours process for outsourced business.
• Minimizes cash settlements vs utilization of preferred suppliers for settlement by managing the
percentage of cash versus quantum.
• Demonstrates an effective communication style, that motivates, across internal and external
teams and individuals that may become involved with claim tasks.