Claims Officer

A dynamic organisation in the General Insurance industry is seeking to fill the position of Claims Officer. The incumbent is expected to handle all aspects of insurance claims on behalf of the company’s clients, from first notice to final payment.

CORE FUNCTIONS

• Investigate and process claims in accordance with regulatory and company guidelines and requirements;
• Evaluate claims, establish and maintain reserves and settle claims;
• Ensure compliance with timelines established in company policies and procedures;
• Provide exceptional service to external and internal customers and act as a resource within the company;
• Respond to telephone and written correspondence from claimants, attorneys, physicians, clients and other related parties;
• Update company’s core computer system with all pertinent information for assigned claims;
• Conduct settlement negotiations with insured party, claimants and attorneys under guidance from Claims Team Leader and/or Head of Claims;
• Exercise sound decision-making on claims assigned, using knowledge of applicable codes, laws, standards and case law;
• Prepare payment requisitions;
• Appoint and work with loss adjusters/assessors, investigators and other external service providers as necessary;
• Liaise with intermediaries, branches, Underwriting and Accounts, and other government agencies to ensure timely resolution of claims;
• Make decisions on denial of coverage, liability or compensability and convey denials;
• Recognise settlement or exposure value and use tools such as structured settlements, arbitration and mediation to assist to settle cases;
• Perform own filing functions and keep all files in good order and appropriately filed in designated areas;
• Perform special projects and other job duties as necessary.