The main purpose of the Claims Specialist’s role is to validate and process short-term insurance liability claims. The Claims Specialist will furthermore provide guidance and advice (legal) on the interpretation of policy wordings, coverage under the respective policies, undertake merit/liability assessments as well as quantification in respect of large and/ or complex claims, deal with litigation and assist with all complaints made to insurance regulatory bodies.
Matric Certificate – essential
A formal Degree in Law is preferred. Alternatively, a formal Degree in Risk Management or Short-Term Insurance
Class of Business certification (Personal Lines & Commercial Lines) – Highly advantageous
Must be compliant with FAIS Fit and Proper requirements with a track record of working unsupervised.
At least 5-10 years of relevant work experience in claims validations and settlement (both in Motor and Non-Motor claims, as well as in both Personal Lines and Commercial Lines classes of business) or work experience in a law firm specializing in dispute resolution, litigation and insurance.
At least 5 years of experience in dealing with all aspects of Liability claims
Experience in dealing with litigious matters
Must be experienced and mandated to make claims settlement determinations for large losses and/ or complex commercial claims (R 2 million or higher)
Work experience within a licensed short-term insurer, or Underwriting Manager
Sound technical knowledge, understanding, and practical application of relevant short term insurance product wording, including niche products such as Marine and Engineering.
Experience in complaints resolution (Regulatory and OSTI related)
Review and approval of rejections
Participation in operational claims management meetings with managers, brokers, and portfolio managers.
Provide key guidance, advice, and recommendation for improvement in policy wordings
Provide governance advice in terms of the relevant legislative and regulatory regime\
Ability to plan and prioritise own time and work commitments to deliver timeous claims service within agreed turnaround times
Ability to think independently and to work without supervision.
Ability to take initiative and respond pro-actively and independently to situations to secure positive results
Accepts ownership and accountability for one’s own actions and decisions
Is open to learning opportunities and is committed to continuous self-development
Ability to communicate openly, and with impact
Ability to adapt one’s communication style and content to the audience and context.
Ability to easily connect with others and develop professional relationships and partnerships with others
Strong listening skills
Demonstrate high levels of customer centricity and empathy
Effective numerical skills and ability to think analytically with good attention to detai