Senior Claims Associate

Negotiate Own Damage or Third Party and Recovery settlements as assigned, in accordance with policy cover within stipulated time frames

DIRECT RESPONSIBILITY FOR:

• Negotiate/Settlement of Own Damage or Third Party claims
• Negotiation of recoveries from Third Party insurers and Third Parties directly  
• Ensuring accuracy of assigned claim files by thoroughly reviewing the data on 4Ds
• Timely updates to clients, provision of good customer service
• Ensure adequacy of Reserves  
• Approve settlements to agreed limit
• Participate in Periodic Claims Review
• Review Investigator’s Report
• Assist the team in achieving monthly recovery target
• Review and prepare file for submission to the arbitration panel
• Check for policy breaches and communicate same to brokers/clients/underwriters
• Any other duty assigned by Supervisor/Manager

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THIS JOB IS WELL DONE WHEN:

• A wide range of claims processing functions on GA’s Information Technology system (Underwriter – 4D) are carried out quickly and accurately, in conformance with GA’s service standards/process targets and with each employee’s Quantifiable Objectives (QOs). These include (but are not limited to):
  • Receiving and viewing loss reports (claim forms, direct clients, telephone calls, demand letters, notice of proceedings and others) to determine liability
  • Adjusting reserves as necessary, within limits of authority
  • Assisting direct walk-in clients to the Claims Department
  • Addressing brokers queries in a timely manner
  • Communicating with internal and external parties (by letters, telephone, e-mail)
  • Reviewing reports from service providers (assessors, adjusters, investigators)  
  • Calculating and outlining settlement for approval by authorizers
  • Discussing approved settlement offers with direct clients/brokers (OD or TP)
  • Preparing releases
  • Preparing payment transactions
  • Following up brokers and insurance companies
  • Referring complex claims, or claims which are or likely to be the subject of court action, or claims likely to be settled in excess of $3.5 million to the Claims Manager, Assistant Claims Manager or Senior Legal Officer
  • Creating and completing follow-ups
  • Creating notes on 4D of all discussions (in person or via telephone) with clients and other parties relating to the claim
  • Linking all communications, including e-mails received outside 4D, to applicable claims
  • Ensuring service action items are created, actioned and then closed
  • Liaising with coinsurers and local reinsurers 
  • Preparing and submitting notes of underwriting recommendations arising out of the claims settlement process/investigation, which could affect renewal terms or decisions to continue on cover  

• Telephone inquiries are responded to in a professional and useful manner
• Claims experience records are prepared on request in time frames required, but within two (2) working days in all cases
• Claims Department meetings are attended and suggestions for improvements in claims processing are made.
• Assistance is offered and delivered to other members of the Claims Department as necessary.
• GA’s attendance and punctuality requirements are met.
• Training opportunities are attended and knowledge is transferred into action.