DIRECT RESPONSIBILITY FOR:
- Negotiate/Settlement of Own Damage or Third Party claims
- Negotiation of recoveries from Third Party insurers and Third Parties directly
- Ensuring accuracy of assigned claim files by thoroughly reviewing the data on 4Ds
- Timely updates to clients, provision of good customer service
- Ensure adequacy of Reserves
- Approve settlements to agreed limit
- Participate in Periodic Claims Review
- Review Investigator’s Report
- Assist the team in achieving monthly recovery target
- Review and prepare file for submission to the arbitration panel
- Check for policy breaches and communicate same to brokers/clients/underwriters
- Any other duty assigned by Supervisor/Manager
_________________________________________________________________________
THIS JOB IS WELL DONE WHEN:
- A wide range of claims processing functions on GA’s Information Technology system (Underwriter – 4D) are carried out quickly and accurately, in conformance with GA’s service standards/process targets and with each employee’s Quantifiable Objectives (QOs). These include (but are not limited to):
- Receiving and viewing loss reports (claim forms, direct clients, telephone calls, demand letters, notice of proceedings and others) to determine liability
- Adjusting reserves as necessary, within limits of authority
- Assisting direct walk-in clients to the Claims Department
- Addressing brokers queries in a timely manner
- Communicating with internal and external parties (by letters, telephone, e-mail)
- Reviewing reports from service providers (assessors, adjusters, investigators)
- Calculating and outlining settlement for approval by authorizers
- Discussing approved settlement offers with direct clients/brokers (OD or TP)
- Preparing releases
- Preparing payment transactions
- Following up brokers and insurance companies
- Referring complex claims, or claims which are or likely to be the subject of court action, or claims likely to be settled in excess of $3.5 million to the Claims Manager, Assistant Claims Manager or Senior Legal Officer
- Creating and completing follow-ups
- Creating notes on 4D of all discussions (in person or via telephone) with clients and other parties relating to the claim
- Linking all communications, including e-mails received outside 4D, to applicable claims
- Ensuring service action items are created, actioned and then closed
- Liaising with coinsurers and local reinsurers
- Preparing and submitting notes of underwriting recommendations arising out of the claims settlement process/investigation, which could affect renewal terms or decisions to continue on cover
- Telephone inquiries are responded to in a professional and useful manner
- Claims experience records are prepared on request in time frames required, but within two (2) working days in all cases
- Claims Department meetings are attended and suggestions for improvements in claims processing are made.
- Assistance is offered and delivered to other members of the Claims Department as necessary.
- GA’s attendance and punctuality requirements are met.
- Training opportunities are attended and knowledge is transferred into action.
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General Accident Insurance Co
Insurance company focused on delivering excellent customer service and implementing process improvement or digital transformation projects in the Insurance or Financial services industry.
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