The learner should be able to process and handle claims within the delegated authority by ensuring validity, assessing liability and negotiating settlement, whilst ensuring excellent customer service and cost containment.
The management of claims should be within the governed framework to ensure compliance with the short term insurance regulations.
Perform administration functions – registration of new claims and loading (and authorization) payments.
Examine and validate new claims and any related documentation thereof.
Adjust claims and ensure that the merits are inline with Sasria policy cover.
Ensure that the appropriate documents supporting the quantum are received and the calculations are correct.
Perform document diary maintenance on IMS system.
Update the reserve as per reserving policy and keep a regular follow-up outstanding proof of quantum.
Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim within delegated authority.
Approve claims within delegated authority after verification of all documents and validation thereof under the policy cover.
Escalate complex and contentious claims to Supervisor.
Manage and ensure that all other external resources and handle the claim within the required procedures and Sasria philosophy.
Update notes on the system regularly to ensure notes reflect latest status of claim.
Inform underwriting department of gaps in cover, omitted documents as well as losses/ gains on premium.
Handle all customer enquiries and queries promptly and in-line with policy.
Requirements
Relevant National Diploma in Finance and/or Accounting.
Employment Echo