Loss Adjuster

1 day left

Montsonyana Staffing Services
Newtown, South Africa
Competitive salary
18 Oct 2019
18 Nov 2019
Job role
Job Purpose

To manage, control and attend to contractor audits, authorizations over-mandate, upfront assessments, customer complaints and enforce correct interpretation of the Homeowners Insurance Policy with panel service providers and clients. Perform a mentoring and coaching support function to Company Insurance, service provides and clients on products and technical aspects where specialised knowledge is required in resolving intricate challenges regarding claims relevant to Homeowners Insurance Cover.
Job Responsibilities

- Assessments of claims: Advise and provide technical support to Company Insurance's claims, underwriting and customer care departments; Minimizing claim losses on within and over-mandate claim; Assess, audit and authorize claims in terms of allowable rates; Ensuring that the claims authorization mandate of R100000 per claim is adhered too.
- Risk Management: Detect and identify fraudulent claims and any overcharging by clients and service providers; Perform risk management function by identifying underwriting risks and inadequate Sum Insured's of dwellings; Ensure adherence to all legislative requirements.
- Policy interpretation of Homeowner's Insurance Cover.
- Vendor Management: Training of service providers (policy wording, processes and rates); Monitoring of service providers (report writing, policy interpretation, claims costs and service); Maintaining and sustaining good business relationship between service providers, clients, Broker Support.
- Reporting and operational efficiency: Ensure quality and accuracy of reports, pricing and workmanship rendered by service providers; Effectively utilize the daily new claims repot to assist in identifying opportunities for further claims assessments.
- Keeping technical skills current and stay abreast for any changes to legislation relevant to Home Owners.
- Arbitrations, second opinions and disputes: Short-Term Insurance Ombudsman matters that require further investigation; Clients proving to the contrary with rejected claims; Complaint against service provider; Client not happy with valuation (insurance replacement cost); As a result of the high cost of second opinions the internal assessor is to ensure that the service providers are suitably skilled and trained.
- People Specification Essential Qualification
- Matric
- 3-year Construction Technology certificate/ Diploma or
- 4-year Building Science or Construction Degree
Training Courses: Fire Investigation, Kwikot Benchmark training
Type of Exposure
- Implementing a strategic plan
- Working with clients to solve client problems
- Investigating and reviewing processes to improve client satisfaction
- Conducting root cause analysis
- Analysing situations or data that requires an in-depth evaluation of multiple factors
- Developing ways to minimize risks
- Managing conflict situations
- Identifying trends
- Conducting gap analysis
- Providing expert advice/opinion
Minimum Experience Level
- Minimum of 3 years as a Building Assessor;
- Minimum of 3 years' experience in the Short-Term Insurance Industry.
Technical / Professional Knowledge
- Banking knowledge
- Business Acumen
- Data analysis
- Governance, Risk and Controls
- Industry trends
- Principles of financial management
- Principles of project management
- Relevant regulatory knowledge
- Relevant software and systems knowledge
- Decision-making process