SIL - Claims Consultant - Motor

  • Standard Bank
  • Constantia Kloof, Gauteng, South Africa
  • Feb 14, 2020
Full Time Insurance & Assurance

Job Description

Job Details

Insurance

Job Purpose

To effectively and timeously deal with all claims, ensure that all received correspondence is actioned, estimates are revised accordingly, payments are effected, recovers effected and the customers are proactively and consistently kept informed. Maintaining and effective diary system to ensure that matters are attended to within agreed or stipulated timeframes, thus enabling effective customer service delivery. With little direct supervision, liaise and interact with customers and other shareholders.

Key Responsibilities/Accountabilities

  • Proactively and consistently keeping the customer informed about progress of a pending claim and restatement of claims procedure
  • Consistent follow ups with the service providers within stipulated timeframes and maintaining and effective diary system
  • Ensuring that all servicing calls are taken and the abandonment rate is maintained within the prescribed limits
  • Ensuring that all claims within the designed portfolio are effectively and timeously processed within the stipulated turn around times
  • Ensure a through understanding of the circumstances of the technical claim and assessment findings before making a determination on whether a reported incident is an insured event falling within the ambit of the policy or not
  • Assertively and persuasively rejecting claimed incidents falling outside the confines of the policy
  • Generating written easily comprehensible formal rejections which is technically sound and factual that is sent to the customers
  • Appointment of a further service provider or specialist, if deemed necessary
  • Adjusting the claims estimates to reflect the potential liability in line with recommendation of service providers or repair quotation
  • Authorising of all repairs falling within the set mandate
  • Generate a weekly report of all claims whose quantum actual or estimated, exceeds R200 000.00
  • Preparing relevant authorisation forms for all claims that exceeds the mandate limits and ensuring that authorisation is expeditiously done
  • Bringing to the immediate attention of management any contentious or borderline claims
  • Making accurate payments based on appropriate supporting documentation, such as repair invoices, duly signed agreements of loss, etc falling within authorised mandate
  • Accuracy and detail of the information captured on the event log notes and other pertinent system updates
  • Ensuring than the customer is provided with all the necessary information if unsatisfied with the rejection, including, inter alia, engaging own specialist service to prove to the contrary, provision of General condition 8 (Dispute or rejection) e.g. management review process), etc
  • Ensuring the claims history is properly checked so as to highlight any relevant risk management action such as enlisting the services of internal forensics division, if deemed appropriate, or recommending policy endorsements
  • Referring any queries or requests or contentious matters to the relevant division(s) especially policy and servicing management immediately
  • Ensuring that any breaches of the service level agreement by panel contractors (service delivery, lack of professionalism, workmanship, etc) are all referred to the relevant department

Preferred Qualification and Experience

  • Minimum educational qualifications should be matric certificate
  • Must be computer literate
  • Insurance related qualifications would be an advantage
  • Must have a minimum of three years insurance experience in Motor Claims

Knowledge/Technical Skills/Expertise

Important relationships

Internal

  • Build secure relationships with all staff within and outside of your portfolio
  • Daily relationship with the new claims area to advise on any noted anomalies or trends that could affect the effective processing of claims
  • Daily relationship building with supply chain management to ensure that the service providers strictly adhere to the current service level agreement
  • Daily interactions with immediate senior or management to advice of any contentious matters or urgent claims that require attention
  • Daily relationship building with policy and servicing management to advise of any policy amendments or client requests / queries
  • Daily relationship building with internal forensics team on making quality referrals on suspicious claims or in need or their expert opinion
  • Daily relationship building with Legal Support and on legal opinions, recoveries and any other related mater

    External

    • Daily relationship with customer base in dealing with queries or providing feedback proactively

  • Daily relationship building with panel or non-panel service providers ensuring customer service delivery
  • Daily relationship with Home Assist ensuring that claims are registered where resultants have occurred due to geyser maintenance issues

    Problem solving, planning and decision making

    • Ability to plan daily activities and ensuring that they are accomplished in conjunction with your supervisor

• Making a determination on whether the reported incident is claimable through correct interpretation and application of the policy
• Ability to peruse, analyse, understand and question the assessment findings before communicating with a customer
• Ability to think laterally in dealing with claims and engaging relevant parties to consult or debate circumstances of claims
• Ability to decide which are the appropriate specialist service provides to engage in each claim, if deemed necessary, such as engineers, etc
• Ability to determine whether the circumstances of a claim are suspicious and warrant referral to management enroute to internal forensics division
• Ability to determine that an endorsement is warranted on a specific policy in light of adverse claims history or particular circumstances
• Ability to handle rejections and difficult client in fair, sensitive and persuasive oral manner while being assertive
• Using own judgement to determine matters that could affect operations and / or customer service delivery and advising supervisor or management accordingly