Responsibilities

Insurance Claims Administration

Review and analyze assigned insurance claims in line with the organization’s standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.

Insurance Claims Evaluation

Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.

Fraud/Financial Crime Investigation

Carry out assigned information and evidence-gathering activities to support the investigation of cases of suspected fraud or financial crime and the instigation of criminal investigations and/or legal actions.

Fraud/Financial Crime Management

Use established prevention models, systems, and protocols to monitor client or customer activities or transactions, informing more senior colleagues about suspicious activities.

Operations Management

Provide operational support by performing a range of routine activities using existing systems and protocols.

Solutions Analysis

Find the most effective ways to respond to routine functional inquiries. Involves following procedures and precedents.

Document Preparation

Prepare moderately complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for reports.

Resolving Customer Issues

Respond to basic issue escalations promptly and appropriately; provide managerial approvals as required.

Regulatory and Compliance Management

Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.

Operational Compliance

Develop knowledge and understanding of the organization’s policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.

Personal Capability Building

Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

Skills

Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Insurance Product Management, Insurance Sales, Oral Communications, Presenting Solutions

Competencies

Action Oriented

Collaborates

Drives Results

Ensures Accountability

Financial Acumen

Instills Trust

Manages Complexity

Optimizes Work Processes

Educatio

NQF Level 3 & NQF Level 2 – Below school leaving