Purpose of the Job: To provide claims handling to ensure prompt and fair settlement of claims.
Reference No: 3643
Location:
Durban, Kwazulu-Natal, ZA
Job Posting Salary: R434,656.00
Job Posting End Date: 19 Dec 2023
Key Performance Areas
To estimate value of loss in terms of DOA
- Review documentation or determine further documentation needed.
- Scrutinize claims documentation (e.g. payslips, etc.)
- Determine and estimate quantum of claims.
To liaise with panel of experts for expert advice
- Consider experts reports particularly actuarial calculations.
- Instruct the relevant experts to quantify the benefits e.g. actuary, industrial psychologists on the advice of and approval of the assessor and/or senior assessor.
To quantify benefits and make appropriate offers.
- If no expert is required, calculate the value of benefits.
- Loss of support/earnings calculation on advice of the Assessor and/or Senior Assessor.
- Provide details of income and fringe benefits in major sectors.
- Determine contingency deductions to be applied.
- Interpretation on the cap limit under the Amendment Act.
- Assess the funeral account and award benefit in terms of the ARAF Act.
- Communicating and explaining offers to claimants.
- Attending to queries with claimants.
- Knowledge of rules of collateral and accelerated benefits.
- Factor in contingencies also consider merits allocated.
- Prepare offer as approved by the Assessor or Senior Assessor.
- Consider any prior payments/interim payments/WCC/Social grants/EIL under the advisement or approval of the assessor or senior assessor.
- Obtain approval in terms of delegation and send out offer.
- If accepted request payment.
- If not accepted revise the offer.
- If summons served, refer matter to Litigation.
To provide claims assistance during road shows
- Drawing files for road shows.
- Liaise with claimants to attend the road show.
Qualifications & Experience
- NQF 7 Bachelor’s Degree or Advanced Diploma qualification
- Relevant 3 years’ experience in claims experience
Technical and Behavioral Competencies required:
- Personal Mastery
- Emotional wisdom
- Ethics and governance
- Customer orientation and customer focus
- Detail orientated and analytical thinker
- Decision making
- Negotiation skills
- Time management
- Leadership skills
- Communication (Written and verbal)
- Computer literacy
