Role Purpose

Responsible for the day to day management and processing of the Life 1st & 3rd Party Claims.

Requirements

• Matric Certificate
• BCom Degree would be an added advantage
• Previous management (junior/senior) in a Claims Department
• Preference given to candidates who have previously worked in an EB environment with a minimum of 3 years
• Working knowledge of Reinsurance claims systems
• Working knowledge of all MS Office Applications
• Prior handling and exposure to any type of 1st party product
• At least 5 years claims management experience
• At least 10 years insurance industry experience
• At least 3 years policy wording interpretation experience

Duties and Responsibilities

• Provide coaching, support, and assistance to claims staff (1st & 3rd Party claims staff)
• Assessment and Management of all PTD Lump Sum, PHI, TTD, GLA, Hospital, Retrenchments, Critical Illness/Dread Disease & Funeral
• Assessment and Management of all Dread Disease, PHI and TTD, PTD Lump Sum payment calculations
• Attend monthly client meetings where applicable
• Ad hoc projects (System enhancements etc)
• Attending to complex 1st & 3rd Party matters
• Ensuring regulatory requirements are adhered to
• Performing claims reviews when required
• Claims sampling on 1st Party claims
• Providing guidance and feedback on complex claims and ensuring fair and equitable decisions are made
• Dealing with applicable Reinsurer on complex claims
• Dealing with clients on referrals
• Making recommendations of changes to policy terms for any client
• To assist with 3rd party claims processing, assessment & management when required by management
• Oversee and perform claim review processes with the focus on mitigating risk exposures to Guardrisk and ensuring overall compliance with regulatory requirements
• The facilitation of identification of gaps/trends or exceptions and escalate to cell captive/binder holder/ PM. Document actions to identify gaps
• Manage and assist, where required with the drafting and presentation of monthly team reports
• To provide ongoing guidance to claims staff on technical aspects
• Maintain and develop new and existing working relationships with internal and external stakeholders
• Understanding Rule 17 of the PPR’s and the TCF framework and the impact it has on day-to-day functions within the business unit
• Management of an effective 1st & 3rd party claims environment
• Continually review internal workflow processes to improve service delivery
• Ensuring that fair and equitable decisions are made on all 1st party claims
• Effective management of complex matters and providing guidance and/or instruction to cell captives/binder holders
• Dealing directly with applicable Reinsurers and relevant stakeholders in the decision-making process, the handling of complex matter and dealing with referrals
• To assist with 3rd party claims management when required by management
• Responsible for the capturing of all claims onto the Cell/Binder Source system and or GR Cell Administration system (Neo)
• Attending to ad-hoc tasks/Projects when required