Claims Fulfillment Consultant - Durban - Pronel Personnel

    Pronel Personnel
    Pronel Personnel Durban

    1 week ago

    pronel personnel background
    Upper Management / Consulting
    Description

    Job Purpose

    We pride ourselves on delivering exceptional customer experiences, both internally and externally. Our team leverages advanced technical knowledge and system understanding to resolve claims efficiently and provide top-notch support. We specialize in building claims, aiming to consistently exceed customer expectations while adhering to regulatory guidelines.

    A. Claims Processing

    Your daily responsibilities include:

    1. Authorizing claims within set parameters and resolving them within agreed-upon productivity targets and turnaround times using the claims diary system effectively.
    2. Applying and communicating technical skills to resolve technical issues utilizing available tools and systems.
    3. Demonstrating a clear understanding and execution of customer complaints and resolutions, as well as claim rejections.
    4. Understanding and following regulated agreements specified by relevant regulatory boards for claims handling.
    5. Ensuring clear understanding of all payments, correct application of rates, and service provider appointment.
    6. Communicating prompt claims resolution through report and quote analysis.
    7. Operating a claims management system and utilizing relevant tools for quick resolution, such as Outlook for emails, SMS, and Excel reporting.
    8. Holding a working knowledge of the internet and Google Maps.

    B. Plan, Communicate, Solve Problems, and Effectively Carry Out Decisions

    1. Treating customers fairly and accurately interpreting reported incidents, claims history, and policy wording.
    2. Communicating technical details to customers and loss adjusters, ensuring lateral thinking and professional engagement.
    3. Having an inquisitive and investigative mindset to identify suspicious activity and report it to the next level if necessary.
    4. Communicating calmly and professionally with difficult customers at all levels, always treating them fairly and sensitively.
    5. Engaging and communicating with specialist service providers, such as engineers.

    C. Practice and Promote Consistent Effective Relationship Building

    Maintaining effective relationships with stakeholders within the organization, including:

    Internal Daily Relationships

    1. Finance Division for payment authorizations and improving service delivery.
    2. Customer Contact Centre for customer communication, complaints, and technical support.
    3. Policy Administration for policy amendments, client queries, and complaint resolution.
    4. Management and peers for daily interactions about contentious matters or urgent claims.
    5. Procurement Manager for service providers' adherence to the service level agreement.
    6. Claims Fulfillment Manager for guidance, assistance, and mentoring.
    7. Operations Manager for growth guidance and communication.

    External Daily Relationships

    1. Customer Service: providing exceptional customer experiences and assisting with queries or feedback.
    2. Panel or non-panel service providers: ensuring professional customer service interactions with loss adjusters and specialists.
    3. Representatives: resolving customer issues and providing assistance.
    4. Internal and external auditors: providing assistance during audits.

    Minimum Requirements

    1. The candidate should respond accurately to technical policy aspects and translate from reports to customers accordingly.

    Preferred Qualification

    1. Insurance-related qualifications, such as FETC: Short Term Insurance NQF 4, RE5.

    Minimum Experience

    1. 4 years of claims experience, preferably in Homeowners/Building Claims.

    Preferred Experience

    1. 5 years of short-term claims insurance experience, preferably with Homeowners/Building experience.

    If you meet the above criteria, please apply directly or send your CV. Due to high volume responses, only candidates meeting the advertised criteria will be contacted.

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