Job Description
Key Duties and Responsibilities
- Assess potential high-value fraudulent claims by evaluating documents and information collected against common indicators of frauds
- Negotiate with corporate customers on settlement amounts, terms and recovery actions in accordance with organisation policies and procedures and applicable laws and regulations
- Communicate all claims decisions in a timely and appropriate manner and ensure that communication during the assessment process is regular, timely, and clearly documented.
- Determine if technical and/or high-value claims should be accepted based on results of claims analysis and reports from service providers
- Determine settlement amounts for technical and/or high-value insurance claims based on investigation outcomes
- Interpret policy wordings and conditions to determine the validity of claims and advises the claimant accordingly
- Negotiate with corporate customers on settlement amounts, terms and recovery actions in accordance with organisation policies and procedures and applicable laws and regulations
- Ensure claim matters are handled according to customer service standards and defined customer experience policies
- Review Key Performance Indicators (KPIs) relevant to each stage of the insurance claims process and propose recommendations to increase efficiency
- Identify claim trends to propose product design enhancements
- Determine appropriate modifications to business processes to ensure seamless transition and minimise resistance for claims handling
- Ensure accuracy of records and adherence to internal controls
- Maintain compliance frameworks, policies, and procedures to reflect changing regulatory requirements and organisational compliance strategies
Key Requirements
Education and Work Experience:
- Bachelor's Degree in Finance, Insurance or any related discipline
- Minimum of 5 to 7 years’ experience in the Insurance industry.
- Possession of a Professional certification is an added advantage
Skills and Competencies:
- Understands the scope of cover, including policy extensions, limitations, and exclusions for the class of business being underwritten
- Sound Knowledge of the Insurance industry
- Ability to apply internal compliance procedures to ensure own work is in compliance with standards
- Strong attention to details
- Excellent written and verbal communication skills
- Excellent customer service skills
- Knowledge of Microsoft Office and Core Insurance software.