Loss Adjustor

TIH is the holding company of some of South Africa’s leading financial service providers. Our portfolio includes short-term insurers, a long-term insurer, health insurance as well as an insurance and personal finance comparison platform. We’re pioneers with a hunger for best, bringing customer-focused innovation and service excellence to the financial services industry.

Job Description

JOB PURPOSE

Deliver and support sound quality of claims decision making, prevent fraud and manage expenditure through the validation of claims by using expert abilities in various fields of investigation.

RESPONSIBILITIES

Needs Assessment

Explore issues or needs, establishing potential causes and barriers as well as related issues. Validate claims by investigating, applying expertise, utilising resources (e.g. police, supplier etc.) and interviewing customers as well as other parties. Analyse specific problems and issues to find the best solutions. Solutions could be technical or professional in nature.

Data Collection & Analysis

Ask questions, collect data from a variety of sources, analyse information and investigate claims. Ensure effective costing of claimed items through ensuring professional, thorough investigation of claims. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools (ITC, supplier contract and / or negotiation) to accurately cost applicable claims on a day to day basis.

Customer Service

Provide a quality service to customers while identifying opportunities to secure new business or support retention. Responsibilities may include processing cases, dealing with complex queries and investigating and resolving customer problems. Uphold agreed service level agreements (set turnaround times) and ensuring customer satisfaction and retention.

Stakeholder Engagement

Effectively build, maintain and manage relationships with service providers and suppliers, colleagues, internal and external customers.

Work Scheduling and Operational Compliance

Contribute to optimise work practices and procedures by maintaining an acceptable workload in order to get the job done, coordinating with support services. Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately).

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. Ensure accurate administration and underwriting of claims. Maintain an acceptable claims expenditure ratio by finalising and adjusting claims accurately.

Compliance

Identify shortcomings in compliance processes, systems and procedures, and develop ad hoc solutions to problems within an assigned unit or discipline.

Up-Sell Customer Propositions

Identify a selection of products or services that may meet the customer's requirements, explain the product / service features influence the customer to add additional cover.

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

Job Requirements

EDUCATION

General Education

Grade 12 / SAQA Accredited Equivalent (Essential); Regulatory Examination (Essential); Science (Mechanical / Physical), Mathematics and African Language (Advantageous); Forensic Investigation Diploma / Insurance Institute qualification (Advantageous)

EXPERIENCE

General Experience

5 or more years work experience in any investigative work OR 2 or more years work experience within one or more of the following fields: insurance / police / forensic / audit / legal (Essential)

ADDITIONAL INFORMATION

• SAQA Accredited Equivalent - it is the onus of the applicant to provide TIH and its subsidiaries with certified evidence that their qualification(s) meet the equivalent NQF level required for this role at time of application. As a registered Financial Service Provider, we are mandated to ensure that all our representatives are and remain fit and proper at all times. By applying for this role, you consent to having your relevant qualification and or accreditation or confirm that you are working towards meeting the competency requirements. You further consent to the relevant information being verified.