Claims Assessor - Non Motor (Pietermaritzburg)

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Job Description

Job Purpose

The role will effectively investigate, adjust and report on assigned claims, thus ensuring containment of all Non Motor claims spend on providing excellent service in setting a culture of best practice within mandated responsibility.

You would:

Process and Understand of Non-Motor claims terms & claim types.

1. Should be aware of escalation metrics and approved channels.
2. Analyzing a problem and formulating its solving approach.
3. Identifying signs and details indicating fraud.
4. Understanding of the non-motor claims policies, activities, and procedures in claims environment.

Understand and Follow the Claims Process

1. Providing prompt & correct assessment.
2. Explore alternatives available for claims assessing and settlement processes, moderation, building rates and service providers.
3. Mapping client needs to company specified.
4. Create collaborative relationships with internal and external process improvements designed to enhance the customer experience and value.
5. Support implementing of new systems and processes.

Delivering the Service to both internal and external stakeholders

1. Actively follow service practices to determine the status of customer service and relations.
2. Proactively identify customer solutions (process, product, systems) to address changing service requirements, ensure customer satisfaction.
3. Establish productive operational relationships with key stakeholders in the various channels and administrative teams.

Cost control and governance adherence

1. Proactively ensure use of time, of resources, money, materials, or equipment is in line with policies and procedures.
2. Comply with corporate governance policies, procedures, and standards.
3. Operate within agreed mandates.

Experience, Knowledge & Skills Required.

1. National Senior Certificate (NSC).
2. Higher Certificate in Short- Term Insurance (NQF 5).
3. 3-5 years Non-Motor Claims experience.
4. Valid South African Drivers Licence.

The Recruitment process:

1. TA Interview: This will be a discussion with a member of the TA Team to give you an understanding of our business, our culture & values and more context on the role.
2. Panel Interview: This will be with 2 members of the senior leadership of the data team and 1 member of the HC leadership team.
3. Technical & Psychometric Assessments: These will depend on the role and will sometimes happen concurrently with MIE & Internal Verification.
4. Final Feedback.

Responsibilities

Insurance Claims Administration

Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.

Insurance Claims Evaluation

Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.

Fraud/Financial Crime Investigation

Contribute to the investigation of cases of suspected fraud or financial crime by gathering, analyzing, and retaining information and physical evidence to support criminal investigation and/or legal action. Recommend further actions to the lead investigator.

Fraud/Financial Crime Management

Analyze data to identify and track and report key trends in activities or transactions that indicate high risk of fraud, and report any specific instances of suspicious activity to more senior colleagues.

Operations Management

Provide operational support services and sometimes act as first-line supervisor of a transactional operations area. Involves using existing systems and protocols.

Solutions Analysis

Interpret data and identify possible answers. Involves navigating a wide variety of processes, procedures, and precedents.

Document Preparation

Organize and prepare complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for special reports.

Resolving Customer Issues

Respond to more advanced issue escalations promptly and appropriately; provide managerial approvals as required.

Regulatory and Compliance Management

Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.

Operational Compliance

Develop knowledge and understanding of the organization's policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.

Personal Capability Building

Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

Skills

Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Presenting Solutions.

Competencies

Business Insight, Collaborates, Decision Quality, Drives Results, Ensures Accountability, Financial Acumen, Instills Trust, Manages Complexity.

Education

NQF Level 5 - Higher, Advance or Occupational Certificate or equivalent.

Closing Date

21 February 2025 , 23:59.

The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.

Old Mutual Limited is pro-vaccination and encourages its workforce to be fully vaccinated against Covid-19.

All prospective employees are required to disclose their vaccination status as part of the recruitment process.

Please refer to the Old Mutual’s Covid-19 vaccination policy for further detail. Kindly note that Old Mutual reserves the right to reinstate the requirement to vaccinate at any point if it is of the view that it is imperative to do so.

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