TIH Careers – Loss Adjustor

Job Description:

Deliver and support sound quality of claims decision making, prevent fraud and manage expenditure through the validation of claims by using expert abilities in various fields of investigation

Job Responsibilities:

• Ensure claims are finalized within the set parameters (turnaround time, terms and conditions applied accurately).
• Remain up to date with current and new quality standards and product knowledge to enable effective decision making.
• Ask questions, collect data from a variety of sources, analyse information and investigate claim. Ensure effective costing of claimed items through ensuring professional, thorough investigation of claims.
• Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.
• Explore issues or needs, establishing potential causes and barriers as well as related issues. Validate claims by investigating, applying expertise, utilizing resources (e.g. police, supplier etc.) and interviewing customers as well as other parties.
• Provide a quality service to customers while identifying opportunities to secure new business or support retention. Responsibilities may include processing cases, dealing with complex queries and investigating and resolving customer problems.
• Identify shortcomings in compliance processes, systems and procedures, and develop ad hoc solutions to problems within an assigned unit or discipline.
• Effectively build, maintain and manage relationships with service providers and suppliers, colleagues, internal and external customers.
• Make decisions according to established criteria to ensure standardization across the organisation by accurately administrating and underwriting claims.
• Uphold agreed service level agreements (set turnaround times) and ensuring customer satisfaction and retention.
• Maintain an acceptable claims expenditure ratio by finalizing and adjusting claims accurately.
• Use appropriate tools (ITC, supplier contract and/or negotiation) to accurately cost applicable claims on a day to day basis.
• Identify a selection of products or services that may meet the customer’s requirements, explain the product/service features influence the customer to add additional cover.
• Ensure accurate administration and underwriting of claims.
• Analyze specific problems and issues to find the best solutions. Solutions could be technical or professional in nature.
• Contribute to optimize work practices and procedures by maintaining an acceptable workload in order to get the job done, coordinating with support services.
• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching.
• Produce, update and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.

Qualification & Experience:

• Science (Mechanical / Physical),
• Grade 12/ SAQA Accredited Equivalent (Essential); Regulatory Examination (Essential);
• Forensic Investigation
• 5 or more years work experience in any investigative work OR 2 or more years work experience within one or more of the following fields: insurance / police / forensic / audit / legal (Essential)
• Diploma / Insurance Institute qualification (Advantageous)
• Mathematics and African Language (Advantageous);

Job Details:

Company: Telesure Investment Holdings – TIH

Vacancy Type:  Full Time

Job Location: Gauteng Area, Gauteng, South Africa

Application Deadline: N/A

Apply Here

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