Claims Controller

About the position

Job Title
Claims Controller - C4
EE Occupational Levels
Level 4 & 5: Skilled, Technical and Academically Qualified
Job Advert Summary
To ensure compliance with the short-term insurance regulations, ensure effective processing of claims 
within the governed framework and management of claims process within assigned mandate. Undertake claims processing by receiving registered claims within mandate, confirm merits within scope of company’s cover, check and maintain correct reserves, regular follow-up on outstanding documents and constant status update to agent companies.
Minimum Requirements
Qualifications:
Relevant Diploma/ Higher Certificate in Insurance preferable
Tertiary qualification preferable (NQF Level 6)
Experience:
4 – 6 years’ experience in a Claims handling position within short-term (non-life) Insurance Industry
Duties and Responsibilities
Claims Processes
- Deal with technically complex claims within their mandate.
- Verify and validate all documents under the policy cover and approve or reject claims within delegated authority.
- Exercise proper judgment and decision-making to analyse the claimed exposure, determine the 
proper course of action and appropriately finalise the claim.
- Escalate complex claims to Line Manager.
- Assist Junior Claims Controllers on technical claims.
- Ensure workflow is managed properly on CMS system.
- Daily (or as required by management) progress reporting.
Stakeholder Management (Agency/Broker & Service Provider Liaison)
- Engage with brokers and Agent companies promptly as required.
- Engage with Underwriting department on cover issues, inform them of gaps in cover and policy 
wording and provide them with any claims related data they may require. 
- Ensure identification of all claims where the appointment of legal representation or litigation is 
required or involved and advise the Line Manager, Claims Manager and relevant Executives. 
- Identify and discuss with Line manager appointment of service providers in line with DOA 
(Delegation of Authority).
- Engage any other department or stakeholder as required for the achievement of divisional goals.
- Manage service level agreements with suppliers and ensure deliverables are satisfactory.
Claims Operations
- Provide input into the improvement of claims processes and procedures in line with best practices. 
- Ensure compliance and risk management policies are adhered to in day-to-day claims activities.
- Assist line management in compiling claims performance statistics. 
- Provide input into potential improvement of policy wording and agent procedure manuals -based on
gaps between company and agent company.
Ad hoc Tasks
Perform any reasonable tasks as and when required by the Line Manager.
 
Application Questions
Application Questions
Do you have a Relevant Diploma or Higher Certificate in Insurance?
  Do you have 4 – 6 years’ experience in a Claims handling position within short-term (non-life) Insurance Industry?

Desired Skills:

• Compiling claims
• risk management
• technical skills