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Job Description

Job Description:

Responsible for making highly complex short term claim settlement determinations.

Reviewing/auditing Claim Files and reserves within time standards.

Correct understanding and application of Policy Terms and Conditions

Daily reviewing/auditing of the claims processed and legal claims.

Daily providing policyholders and Brokers with excellent service.

Regularly keeping policyholders and Brokers informed on the status of their claims.

Regularly liaise with internal support divisions, i.e. Salvages Department.

Visiting external stakeholders.

Continuous improvement to ensure effective service

Actively participate in problem solving activities to define problems, assess current state root causes, design and test solutions, implement solutions, and sustain and continuously improve to permanently eliminate problems.

Actively participates in continuous improvement by fully engaging in daily huddles, generating suggestions, following appropriate procedures and continuous process improvement work principles, participating in problem solving activities, and utilizing continuous improvement tools to support the work of the team.

Ensure statutory and legislative knowledge is always current in order to resolve customer complaints, to advise the business on corrective solutions to mitigate risks and to improve the customer experience whilst complying with governance requirements.

Ensure adherence to organisational policies, practices and procedures.

Identify solutions to enhance cost effectiveness and increase operational efficiency

Service delivery to ensure customer satisfaction

Maintain service, quality and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures and standards.

Establish productive operational relationships with key stakeholders in the various channels and administrative teams.

Develop work routines in line with operational plans / schedules in order to manage achievement of service delivery goals.

Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.

Cost control and governance adherence

Proactively ensure use of time, of resources, money, materials or equipment is in line with policies and procedures.

Comply with corporate governance policies, procedures and standards.

Operate within agreed mandates.

Quality people practices

Align own behaviour with the organisation culture and values.

Share and transfer product, process and systems knowledge to colleagues.

Ensure achievement of own performance objectives.

Actively share information with other team members regarding successes, issues, trends and ideas.

Actively participate in own professional development and career path.

Actively promote a culture of learning and high performance culture amongst team members.

Applicants must be in possession of a post-Matric commercial qualification (NQF Level 6-7 or equivalent) or studying towards one.

2 years’ relevant Trade Credit or Claims experience.

Must have accounts receivable and credit control experience.

Debtor’s department experience will be beneficial

Handles a variety of coverage with a defined loss potential. Reviews and proceses claims of low to moderate face value or liability against policies and coverage information. Decision-making is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subject-matter experts for additional data. Settles and negotiates claims within authorised authority.

ResponsibilitiesInsurance 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

Carry out assigned information and evidence-gathering activities to support the investigation of cases of suspected fraud or financial crime and the instigation of criminal investigations and/or legal actions.

Fraud/Financial Crime Management

Use established prevention models, systems, and protocols to monitor client or customer activities or transactions, informing more senior colleagues about suspicious activities.

Operations Management

Provide operational support by performing a range of routine activities using existing systems and protocols.

Solutions Analysis

Find the most effective ways to respond to routine functional inquiries. Involves following procedures and precedents.

Document Preparation

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

Resolving Customer Issues

Respond to basic 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

Competencies

Action Oriented

Collaborates

Drives Results

Ensures Accountability

Financial Acumen

Instills Trust

Manages Complexity

Optimizes Work Processes

Education

Closing Date

11 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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