Claims Assistant (General Insurance) Britam

Job Purpose

• Claims Processing
• Receive, register, and acknowledge claims from clients and intermediaries.
• Verify submitted claims documents for completeness and accuracy.
• Capture claims details into the claims management system promptly.
• Claims Assessment and Documentation
• Assist in assessing the validity of claims by cross-referencing policy terms and conditions.
• Ensure all supporting documents such as police reports, medical reports, or repair estimates are collected and recorded.
• Liaise with service providers (e.g., garages, hospitals) to verify claims information and costs.
• Carry out a thorough claims review process to ensure our reserves are up to date
• Maintain low loss ratios through thorough negotiations and assessments
• Claims Settlement
• Follow up on claims approvals and payments within the stipulated timelines.
• Assist in resolving discrepancies or issues arising from claims processing.
• Prepare claims payment requests and ensure accurate records of payments made.
• Customer Service
• Communicate with claimants and brokers to provide updates on the status of claims.
• Address and escalate client complaints or queries in a timely manner.
• Provide guidance to clients on claims submission requirements and procedures.
• Compliance and Reporting
• Maintain proper filing of claims records for reference and audit purposes.
• Ensure all claims are processed in compliance with company policies, insurance regulations, and service-level agreements.
• Generate and submit periodic claims reports to the Claims Officer.
• Collaboration and Teamwork
• Coordinate with underwriting, risk assessment, and legal teams on claims-related matters.
• Work closely with external assessors, surveyors, and investigators to facilitate claims processing.
• Support other team members during high workloads or tight deadlines.
• Risk and Fraud Management
• Highlight suspicious or fraudulent claims to the Claims Officer for investigation.
• Assist in implementing controls to mitigate claims fraud risks.
• Reinsurance Claims Recoveries and Third-Party recoveries
• Communicate with reinsurers to notify them of claims and initiate the recovery process.
• Provide documentation for all reinsurance related claims to the reinsurers
• Follow up on reinsurance debt to monitor the status of reinsurance claims
• Provide regular updates and reports on recovery status, including any delays
• Work closely with claims, underwriting, finance and legal departments to ensure smooth reinsurance and third-party recovery process
• Ensure all documents and files related to third party recoveries are up to date with regular reporting.
• Continuous Improvement
• Contribute to process improvements to enhance efficiency and customer satisfaction in claims handling.
• Stay updated on industry trends, regulatory changes, and claims management best practices.