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Job SummaryResponsible for efficiently end to end management of claims. This involves receiving, assessing, analysing, investigating, and settling insurance claims in a timely and accurate manner using all available information to formulate a fair settlement to claimants.
Professionally liaising with third parties, such as investigators, insurers, and other experts, as well as managing paperwork, preparing reports, and liaising with customers.
Job Description
Accountability: End to end management of the Claims process. 50%
- Receive, register, manage and settle claims according to company procedures and IRA guidelines.
- Maintain adequate initial reserves as per reserve guidelines and participate in the periodic reserving reviews.
- Receive and assess claim documentation for ALAK products in line with product specifications.
- Track and follow up on receipt of necessary claim requirements.
- Ensure that claims and payments are processed within the ALAK Claims Best Practice Guidelines.
- Proactive negotiation and appropriate resolution on claims issues raised.
- Collaborate with internal stakeholders for improved products, processes, and experience investigation.
- Constantly seek to improve ways of working by challenging the status quo and supporting an empowering climate within the team, sharing knowledge, experience, best practice and providing constructive feedback as required.
Accountability: Deliver professional and efficient customer service to distribution partners.20%
- First point of contact for all claims related matters and appropriate escalation.
- Build and maintain effective relationships with all internal and external stakeholders.
- Ensure that all claims’ queries are responded to and resolved in a timely manner.
- Adhere to the Query and complaint categorization and response standards to ensure client queries and complaints are dealt and recorded timeously, efficiently, and professionally.
Accountability: Reporting 20%
- Prepare claims management reports periodically as scheduled.
- Review claims data to identify patterns and trends.
- Conduct research and market intelligence and present in reports.
- Prepare and present claims information to internal and external stakeholders.
- Preparation and submission of all regulatory returns and reports.
- Prepare Internal and external Audit reports, forecasts and reviews.
Accountability: Reinsurance -5%
- Keep reinsurance up to date with the current reinsurance position and work with reinsurers on contentious claims to ensure a successful outcome.
- Ensure that treaty claims recoveries are pursued aggressively.
- Prepare Internal and external Audit reports, forecasts, and reviews.
Accountability: Control Environment (5%)
- Delivering operational excellence in achieving quality, cost, and service standards on assigned work from time to time.
- Ensure that all activities and duties are carried out in full compliance with regulatory requirements, Enterprise-Wide Risk Management Framework and internal Absa Policies and Policy Standards. Understand and manage risks and risk events (incidents) relevant to the role.