Claims Analyst OMLAU

Lets Write Africa's Story Together!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

Resolving claims efficiently and fairly in a manner that promotes the company’s brand values and provides consistently high standard of customer service across the whole organization.

• Registering all claims as they come in for processing.
• Investigating the nature of the claims where necessary and determining insurance policy coverage and reserving.
• Working closely with the other team members including legal consultants and escalating matters as appropriate within timelines.
• Maintenance of proper records with details of the claims processed, paid and outstanding.
• Providing weekly and monthly claims reports for management consideration.
• Notification to Reinsurance Officer in respect to recoveries.
• Follow up to obtain full documentation pertaining claims
• Follow up of all claims to ensure timely payments
• Follow up of Discharge vouchers sent to clients
• Coordinate review meetings with both clients and company to monitor services
• Undertake any other duties as required commensurate with the level of the position.

Qualifications:

A bachelor’s degree in actuarial science or any business-related courses. Professional qualifications such as ANZIF, ACII, DIP CII, AIA DIP-ITC will be an added advantage.

Experience:

• 5 years’ work experience in underwriting and claims.
• Practical knowledge of life Assurance business functions and operations and awareness of relationships between functional areas of operation.
• Ability to work efficiently and methodically to effectively manage caseload and use own initiative.
• A willingness and ability to learn given that the law changes over time and keeping abreast of new case law and groundbreaking decisions that give the company an advantage when defending claims.

4. SKILLS AND COMPETENCIES.

• Attention to detail
• Strong analytical skills in order to be able to assess the merits of any claim and understand the liabilities of insured clients.

• Computer skills
• Communication and interpersonal skills
• Self-organisation skills
• Prioritisation skills

• Ability to work with minimum supervision

Handles 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. Decision-making is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subject-matter experts for additional data. Settles and negotiates claims within authorised authority.

ResponsibilitiesInsurance Claims Administration

Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter 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

Carry out assigned information and evidence-gathering activities to support the investigation of cases of suspected fraud or financial crime and the instigation of criminal investigations and/or legal actions.

Fraud/Financial Crime Management

Use established prevention models, systems, and protocols to monitor client or customer activities or transactions, informing more senior colleagues about suspicious activities.

Operations Management

Provide operational support by performing a range of routine activities using existing systems and protocols.

Solutions Analysis

Find the most effective ways to respond to routine functional inquiries. Involves following procedures and precedents.

Document Preparation

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.

Resolving Customer Issues

Respond to basic 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 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.

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, Action Planning, Analytical Thinking, Brand Values, Business, Business Functions, Case Law, Claims Management, Claims Reporting, Claims Settlement, Codes of Conduct, Communication, Customer Follow-Ups, Customer Service, Customer Service Standards, Data Compilation, Data Controls, Decision Making, Documentations, Executing Plans, Financial Auditing, Insurance, Insurance Claims, Insurance Claims Investigations, Insurance Product Management {+ 16 more}

Competencies

Action OrientedCollaboratesDrives ResultsEnsures AccountabilityFinancial AcumenInstills TrustManages ComplexityOptimizes Work Processes

Education

Bachelors Degree (B): Actuarial Science (Required), Bachelors Degree (B): Business Administration (Required), Diploma (Dip): Insurance (Required)

Closing Date

28 April 2025 , 23:59

The Old Mutual Story!