Role Profile:
- This is a customer facing role to efficiently manage a portfolio of property claims within prescribed service and technical standards. To agree the settlement of claims in accordance with policy terms and conditions and within your own authority levels, to ensure such settlements are achieved in an efficient, accurate and timely manner. Where appropriate to undertake the recovery of our outlay from the third-party insurer.
Essential Job Functions:
- Claims Handling
- Claims Notification and Investigation
- Interprets policy wordings and conditions to determine the validity of claims
- Handles claims in line with authority limits and adheres to organisational referral procedures
- Identifies when a specialist is needed to investigate a claim and follows organisational policies and procedures for appointing these
- Identifies potential non-disclosure or misrepresentation and applies the relevant legal principles in the investigation of them
- Identifies where reinsurance is in force for particular claims and complies with reinsurance notification procedures.
Claims Management:
- Creates and reviews reserves in line with organisational reserving policy
- Demonstrates an understanding of relevant protocols, market agreements and regulatory requirements that impact on the way claims are managed
- Works within the parameters of any service standards or service level agreements with other claims management service organisations (e.g. outsourcers and third party administrators)
- Identifies and manages potential conflicts of interest in line with organisational policies and procedures.
- Keeps accurate and complete records of communications and business transactions in accordance with company procedures
- Investigates circumstances and obtains all relevant information to bring about a timely liability decision.
- Makes sound decisions based on the available information, own experience and consideration of all possible outcomes.
- Identifies any claims which are potentially fraudulent and follows organisational procedures for dealing with these
- Negotiates in a timely manner to provide cost effective solutions for the company and its customers
- Identifies and monitors claims leakage in own area of business and makes recommendations for improvement.
Claims Settlement:
- Identifies the most appropriate method of settling claims in line with organisational policies and procedures
- Able to negotiate and agree settlement of a claim with all parties concerned.
- Settles claims in line with authority limits and adheres to referral procedures.
- Notifies stakeholders of claims settlement decisions.
- Evaluates the options available to pursue subrogation and recovery rights and takes action accordingly
- Identifies where reinsurance is in force for particular claims and complies with reinsurance settlement procedures
Qualifications:
- Minimum of Cert CII
Experience:
- Experience of working in a similar claims handling role.
- Understanding of the recovery process and subrogation rights.
- Functional/Technical Competencies
- Excellent attention to detail
- Must be MS Office proficient including Word and Excel
- Strong interpersonal and customer service skills
- Strong verbal and accurate written communication skills
Sector:
- General Insurance
