Specialist - Claims Advisory

Vista previa de la oferta

Specialist - Claims Advisory

Risk & Compliance

Company:

Description:

We are seeking a talented individual to join the Claims Operations department at Marsh. This role will be based in Durban, hybrid and has a requirement of working at least three days a week in the office.

The Claims Operations Consultant independently manages client claims by receiving, reviewing, and processing new submissions, verifying coverage, and notifying relevant insurers and stakeholders. This role involves updating claims systems, tracking progress through each stage, and ensuring completion of all Marsh responsibilities. The consultant oversees and facilitates all subsequent claim activities, including settlement, payment, and reporting, through to final claim closure.

We will count on you to:

Claims Process

• Review and analyse incoming documentation, seeking guidance or advice as needed.

• Identify all relevant policies and coverages, validate as necessary, and request clarification when uncertain.

• Promptly enter or update claims information in the appropriate claims systems, adhering to local service standards.

• Distribute new claim notifications and updates to insurers and relevant stakeholders for all applicable policies and coverages.

• Liaise and communicate with clients, Marsh colleagues, third parties, attorneys , insurers, and other stakeholders to provide status updates, request information, and query resolution .

• Complete thorough liability investigation and obtain relevant documents/information  in order to determine appropriate action for resolution of the case

• Facilitate information requests between insurers ,clients ,third parties and other stake holders

• Process and  provide support and guidance to clients and/or Marsh internal colleagues for liability claims which fall within the deductible

• Validate claims to ensure accuracy ,compliance with policy terms and fair settlement

• Negotiate settlement , where appropriate within agreed authority limits

• Prepare settlement documentation and where appropriate facilitate collection of claims monies

• Monitor incoming (and outstanding) funds from insurers and other relevant parties (aggregates / floats / funds), prepare payment requisitions where applicable to facilitate payment to client/beneficiary

• When authorized, appoint qualified loss adjusters and/or relevant service providers to support claim assessment, evaluation, and timely resolution.

• Maintain accurate and up-to-date claims records in systems

• Provide clients and/or beneficiaries with claim status updates and follow up with insurers /attorneys on outstanding receivables.

• Generate, validate, and distribute claims reports as required.

• Participate in meetings with internal stakeholders, clients, insurers, and third parties as needed.

• Understand clients’ business objectives and Marsh processes and proactively suggest improvement opportunities through local management.

Claims Management Responsibilities

• Comply with regulatory requirements and Marsh’s professional standards to ensure quality and mitigate potential Error & Omission (E&O) risks.

• Build and maintain strong relationships with clients, colleagues, third parties, and insurers.

• Communicate effectively and professionally with all stakeholders, following local procedures.

• Keep all claims applications, records, and files accurate and up to date.

• Proactively manage tasks to meet local or client service standards and Key Performance Indicators (KPIs).

• Prioritize and manage workload to meet deadlines and service commitments, escalating issues or seeking support as needed.

• Take ownership of personal development by continuously enhancing knowledge and skills.

Technical Claims and Escalation Management

• Assess escalated claims processing issues, providing resolutions or escalating as appropriate.

• Demonstrate through understanding of liability and other Lines of Business (LOB) placements, markets, internal procedures, and Third-Party Administrators (TPAs).

• Liaise with attorneys , insurers and loss adjusters regarding claim notifications, updates, information requests, queries, and acknowledgments.

• Coordinate with advocates and client executives on specific claim issues or client service concerns.

• Keep all relevant parties informed of potential problems, contentious claims, or emerging claims trends.

• Assist in resolving issues with non-paying insurers to facilitate outstanding settlements.

• Participate in internal and external audits, providing feedback and recommendations for process improvements.

What you need to have:

• Matric – Grade 12 High School qualification required

• Diploma or University degree preferred (or equivalent experience)

• Legal degree /diploma advantageous 

• Minimum 5 years’ clamis handling experience

• Corporate claims experience beneficial

• Liability claims experience beneficial

• Ability to manage complex claims and multiple stake- holders

• Self-insurance, aggregate, reinsurance and captive knowledge

• Excellent decision-making skills

• Experience in a client-facing role

Why join our team:

• We help you be your best through professional development opportunities, interesting work and supportive leaders.

• We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have impact for colleagues, clients and communities.

• Our scale enables us to provide a range of career opportunities, as well as benefits and rewards to enhance your well-being.