Purpose of the Role

To independently assess claims, apply interpretive judgment on coverage and liability, manage customer and intermediary interactions, and ensure balanced risk control and customer experience outcomes.

Overview of Role Responsibilities (Level 1-13)

Insurance Claims Administration- Level 4 - Process Expert
Process assigned straightforward insurance claims, meeting defined customer service standards and ensuring that each claim is supported by valid documentation and supporting evidence. Authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.

Insurance Claims Evaluation- Level 4 - Process Expert
Interview and/or visit claimants to evaluate straightforward low-value claims. Determine the value of insured losses in line with the organization's claims policies and the contractual terms of the insurance policy, referring complex or disputed claims to senior colleagues for resolution.

Document Preparation- Level 4 - Process Expert
Prepare moderately complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for reports.

Operational Compliance- Level 4 - Process Expert
Develop knowledge and understanding of the organization's 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.

Operational Risk Management- Level 4 - Process Expert
Perform in-depth operational risk assessments and develop appropriate mitigation tactics for complex situations.

Required Skills

Claims Management - Intermediate
Works at an intermediate level to handle individual and portfolios of claims cost effectively, minimizing claims leakage, and meeting organizational and customer claims service standards. Typically works with guidance.

Claims Handling - Intermediate
Works at an intermediate level to use and apply processes and procedures for processing claims by an intermediary. Typically works with guidance.

Claims Settlement - Intermediate
Works at an intermediate level to agree quantum and settle claims, identifying any opportunities for recoveries and its application. Typically works with guidance.

Claims Notification and Investigation - Intermediate
Works at an intermediate level to use and apply the claims notification process, and validate and investigate claims. Typically works with guidance.

Insurance Principles and Practice - Intermediate
Works at an intermediate level to use and apply the core principles of insurance. Typically works with guidance.

Insurance Products and Services - Intermediate
Works at an intermediate level to use and apply the full range of insurance products and services in the market. Typically works with guidance.

Education

General Experience

Sound experience and understanding of straightforward procedures or systems (Minimum 1 year)

Required Behavioural Competencies