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SOUTH AFRICAN SPECIAL RISK INSURANCE ASSOCIATION (SASRIA) - COMPLEX CLAIMS CONTROLLER
SOUTH AFRICAN SPECIAL RISK INSURANCE ASSOCIATION (SASRIA)
Position Title: Complex Claims Controller
JOB SUMMARY STATEMENT/PURPOSE:
The Complex Claims Controller will ensure effective processing of claims within the governed framework, to ensure compliance with the short-term insurance regulations as well as to assist the Claims Manager with the management of complex claims.
CURRENT STATUS: Active
CONTRACT TYPE: Fixed-Term Contract
CLOSING DATE: September 22, 2021
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Qualifying Criteria
Key Performance Areas (Duties & Responsibilities):
1. Claims processes
• Undertake claims processing by receiving registered claims that are within mandate, check & maintain correct reserves and keep a regular follow-up on outstanding documents
• Approve and settle claims within delegated authority after verification of all documents and validation thereof under the policy cover
• Assist in the extrapolation of monthly reports on claims
2. Agency/ broker Liaison
• Inform reinsurers, brokers, underwriting & legal departments and loss adjusters accurately and promptly of large losses
• Exercise proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim
• Ensure identification of all claims where appointment of surveyors, adjusters or legal representation or litigation is involved and advise the Claims Manager and relevant Executives
• Interpret related claims documentation and negotiate settlement and disposition of complex claims
Qualifying Criteria
Key Performance Areas (Duties & Responsibilities):
1. Claims processes
• Undertake claims processing by receiving registered claims that are within mandate, check & maintain correct reserves and keep a regular follow-up on outstanding documents
• Approve and settle claims within delegated authority after verification of all documents and validation thereof under the policy cover
• Assist in the extrapolation of monthly reports on claims
2. Agency/ broker Liaison
• Inform reinsurers, brokers, underwriting & legal departments and loss adjusters accurately and promptly of large losses
• Exercise proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim
• Ensure identification of all claims where appointment of surveyors, adjusters or legal representation or litigation is involved and advise the Claims Manager and relevant Executives
• Interpret related claims documentation and negotiate settlement and disposition of complex claims
3. Strategic assistance
• Provide input in the compilation of the departmental annual plan
• Provide input on the review of the claims processes
• Review and enhance the claims procedure manual for evaluation by the Claims Manager
• Continuously review departmental risks
• Establish gaps between industry developments and Sasria covers
• Compile Statistical Reports
• Manage service level agreements with suppliers and ensure deliverables are satisfactory
4. Perform ad hoc tasks
• Perform any reasonable tasks as and when required by the Line Manager
Qualifications:
- Degree / Diploma preferable
- Higher Certificate in Insurance preferable
Experience:
- 7 – 10 years’ experience in a Claims position of short-term Insurance company
Knowledge:
- Sound knowledge of claims procedures
- Understanding of claims analysis and settlement
- Understanding relevant legislation
- Understanding of Short Term, commercial and property insurance
Technical Skills:
- Administration
- Analytical thinking
- Business writing
- Claims management
- Communication
- Customer service
- Interpersonal skills
- Liability analysis
Behavioural Competencies:
- Analysing information
- Managing information
- Communicating clearly
- Team working
- Handling conflict
- Customer centricity
- Managing work
- Driving results
Demographics:
- A South African citizen of any gender, preference will be given to an EE candidate
Location of the role:
- The role will be in Illovo, Johannesburg