a variety of coverage with a defined loss potential. Reviews and proceses claims of low to moderate face value or liability against policies and coverage information. Decisionmaking is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subjectmatter experts for additional data. Settles and negotiates claims within authorised authority.Responsibilities
Insurance Claims Administration
Review and analyze assigned insurance claims in line with the organizations standard claims procedures and customer service standards. Engage loss adjusters and/or subjectmatter experts where appropriate authorize claims within delegated authority and refer complex or unresolved issues to senior colleagues.
Insurance Claims Evaluation
Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits referring complex or disputed claims to senior colleagues for resolution.
Fraud/Financial Crime Investigation
Contribute to the investigation of cases of suspected fraud or financial crime by gathering analyzing and retaining information and physical evidence to support criminal investigation and/or legal action. Recommend further actions to the lead investigator.
Fraud/Financial Crime Management
Analyze data to identify and track and report key trends in activities or transactions that indicate high risk of fraud and report any specific instances of suspicious activity to more senior colleagues.
Operations Management
Provide operational support services and sometimes act as firstline supervisor of a transactional operations area. Involves using existing systems and protocols.
Solutions Analysis
Interpret data and identify possible answers. Involves navigating a wide variety of processes procedures and precedents.
Document Preparation
Organize and prepare complex documents using a variety of applications for technology devices such as standard office software. Also responsible for gathering and summarizing data for special reports.
Resolving Customer Issues
Respond to more advanced issue escalations promptly and appropriately; provide managerial approvals as required.
Regulatory and Compliance Management
Carry out a wide range of compliance monitoring activities and give basic advice on compliance and regulatory requirements.
Operational Compliance
Develop knowledge and understanding of the organizations policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure.
Personal Capability Building
Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology external regulation and industry best practices through ongoing education attending conferences and reading specialist media.
Skills
Action Planning Claims Management Claims Settlement Data Compilation Data Controls Executing Plans Financial Auditing Insurance Claims Investigations Oral Communications Presenting SolutionsCompetencies
Business InsightCollaboratesDecision QualityDrives ResultsEnsures AccountabilityFinancial AcumenInstills TrustManages ComplexityEducation
NQF Level 5 Higher Advance or Occupational Certificate or equivalentClosing Date
10 April 2025 23:59The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.
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