Claims Controller

Closing Date2023/05/03
Reference NumberSAS230418-1
Job TitleClaims Controller
Job TypePermanent
DivisionInsurance Operations
DepartmentClaims
EE Occupational LevelsLevel 2 & 3: Semi-skilled
Location – Town / CityJohannesburg
Location – ProvinceGauteng
Location – CountrySouth Africa
Job Advert SummaryTo collate records and examine information to assist in determining claim settlements, within the 
governed framework to ensure compliance with the short term insurance regulations or to determine
the validity of the claims from agent companies, assess the liability and negotiate settlements.
Minimum RequirementsQualifications:• Higher Certificate in Insurance NQF5 (preferable)
• Tertiary education (preferable)Experience:• 3 – 5 years experience in a Claims position of Short term Insurance company
Duties and ResponsibilitiesClaims Processes:• Accurately record and examine received claims and any related documentation thereof.
• Perform document diary maintenance on CMS system.
• Assess claims received by the department for reserve and keep a regular follow-up outstanding reserve once claims are verified by Claims Manager.
• Approve claims within delegated authority after verification of all documents and validation thereof under the policy cover.
• Escalate complex claims to Supervisor.
• Assist in the extrapolation of monthly reports on claims.Agency/ broker Liaison• Inform underwriting department of gaps in cover and/or wording documents as well as adjustors such as losses/ gains on premium.
• Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim.• Negotiate the settlement and disposition of claims within prescribed mandate; interpret related claims documentation.Perform ad hoc tasks• Perform any reasonable tasks as and when required by the Line Manager.

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