Specialist Claims Advisor is a claims handler, who is able to independently service clients. Receives new claims from clients and/or colleagues to review, process, collect information and notify all appropriate insurers. Role identifies and validates coverage information; updates core claims applications and tracks
the process through to completion of each claims movement or until finalization of the company responsibilities agreed with the client. Role will manage, facilitate and action all subsequent movements or activities, including settlement or payment as appropriate and reporting, through to completion of the claim.
The below are non – negotiables:
- Corporate claims administration experience
- All classes of liability claims.(Professional Indemnity, Directors and Offices, Employers Practice Liability, Cyber risk, General Liability
- Financial Lines claims experience – High profile clients (ie. Bankers, Profession, Realty etc.)
- Aggregate / self-insurance /Cell Captive / Global placement claims handling experience.
Responsibilities:
Claims Process
- Review and understand incoming documentation seeking guidance or advice where necessary
- Identify all potential policies and coverages, seek validation where necessary, and advice where uncertain or clarification required
- Promptly enter or update claims information into appropriate claims application(s) in compliance with any local service standards
- Distribute (report) new claim notifications, or updates, to all insurers for all policies or coverages
- Communicate with clients, colleagues, third parties or insurers for status updates, information requests, instructions or query resolution
- Facilitate information requests between insurers and clients
- Prepare settlement documentation and where appropriate facilitate collection of claims monies
- Monitor incoming (& outstanding) funds from insurers, prepare payment requisitions where applicable to facilitate payment to client/beneficiary
- Communicate with clients or beneficiaries to provide status updates, and follow-up with insurers or otherwise for outstanding receivables
- Generate claims reports as required, validate, supplement and distribute as necessary
- Attend meetings with clients, insurers or third parties as required
- Interpreting clients business drivers and company processes, consider and suggest improvement opportunities, initially via local company management
Claims Management Responsibilities
- Adhere to compliance/regulatory requirements, or company’s Professional standards to maintain quality & avoid potential Error & Omission (E&O) situations
- Build and maintain effective relationships with clients, colleagues, third parties or insurers
- Effectively communicate with clients, colleagues, third parties or insurers as appropriate at all times, and as per local procedures
- Ensure all applicable claims applications, records and files are kept up to date at all times
- Proactively handle tasks and activities to ensure adherence to local or client service standards, or Key Performance Indicators (KPI’s)
- Manage and prioritize workloads to meet deadlines, service standards or deliverables, escalate or seek assistance where necessary
- Take ownership of your own personal development, maintaining and improving knowledge and skills
Technical Claims and Escalation Management
- Demonstrate an escalated degree of control with regards’ to Operational Risk exposures for significant claims
- Judge escalated issues pertaining to claims processing, provide resolution or defer to others as appropriate
- Demonstrate thorough understanding of Line of Business (LOB) placements, markets and internal/external procedures, including Third Party Administrators (TPA’s)
- Liaison with insurers on claims notifications, updates, information requests, queries, acknowledgements or other issues
- Liaison with advocates and/or client executives for specific claim related issues, or client service concerns
- Keep all relevant parties informed, as appropriate, of any potential problems, contentious claims or general claims trends
- Provide assistance and/or guidance in resolving issues with non-paying insurers for outstanding settlements
- Participate in internal and external audits as appropriate, where applicable, provide feedback & recommendations for improvements
Education
- At least Secondary or High School qualifications required
- Diploma or university degree preferred (or equivalent experience)
- Diploma in contractual Law – Beneficial
Experience
- Minimum 5 years’ work experience
- Minimum of 3 years Corporate claims: General Liability, D&O Liability,
- Professional Indemnity, Employers Liability, Financial lines Claims experience – Essential
- Non-Motor and Motor corporate claims handling experience
- All Lines of Business experience
- Self-insurance claims handling knowledge.
Knowledge and Skills
- Clear and concise oral and written communication skills
- Strong numerical skills
- Excellent organization skills – able to prioritize work and meet deadlines
- Excellent interpersonal skills – able to work within a team
- Comfortable and experience working with technology (solutions)
- Proficient in Microsoft Office tools (or equivalent) – Outlook, Word and Excel
- Insurance/ claims handling knowledge
- Relevant industry practice or Line of Business experience
- Insurance market, clients and claims management skills related to area of expertise
- Strong networking skills
- Strong problem solving capabilities
Desired Skills:
- Corporate claims administration
- All classes of liability claims
- Financial Lines claims
Desired Work Experience:
- 5 to 10 years
Desired Qualification Level:
- Degree
About The Employer:
Our client is a Insurance Corporate client based in Sandton.