Junior Claims Clerk

Description:

A reputable company based in the West Rand requires a Junior Claims Clerk

DUTIES:

• Capture new geyser claims on the system with accurate client, policy, and incident details.
• Verify policy status, cover type, excess amounts, and waiting periods before processing.
• Allocate claims to assessors, plumbers, or service providers based on location and urgency.
• Maintain updated claim notes, documentation, and correspondence on the claims platform.
• Request and review required documents such as photos, plumber reports, invoices, and proof of ownership.
• Confirm cause of damage (burst, leak, thermostat failure, corrosion, etc.) against policy wording.
• Check for possible exclusions, pre-existing damage, or non-compliance with installation standards.
• Validate quotations and ensure they align with insurer-approved rates.
• Contact policyholders to explain the claims process, required documents, and next steps .
• Liaise with plumbers, assessors, and suppliers to schedule inspections or repairs.
• Provide claim status updates and manage expectations regarding timelines and approvals.
• Handle basic queries, escalate complex issues to senior claims handlers when necessary.
• Capture approved payments, including plumber call-out fees, replacement geyser costs, and reinstatement work.
• Ensure excesses are correctly applied and communicated to the client.
• Reconcile invoices and check for discrepancies before payment.
• Monitor turnaround times and follow up on outstanding reports or documents.
• Assist with logging supplier performance issues or delays.
• Support senior claims consultants with bulk claims during peak seasons (e.g., storms, winter).
• File, archive, and maintain claim records in line with compliance requirements.
• Adhere to internal claims procedures, SLA requirements, and regulatory standards.
• Flag suspicious or potentially fraudulent claims for further investigation.
• Ensure all communication and documentation meets audit and compliance standards.

Requirements:

A reputable company based in the West Rand requires a Junior Claims Clerk

DUTIES:

• Capture new geyser claims on the system with accurate client, policy, and incident details.
• Verify policy status, cover type, excess amounts, and waiting periods before processing.
• Allocate claims to assessors, plumbers, or service providers based on location and urgency.
• Maintain updated claim notes, documentation, and correspondence on the claims platform.
• Request and review required documents such as photos, plumber reports, invoices, and proof of ownership.
• Confirm cause of damage (burst, leak, thermostat failure, corrosion, etc.) against policy wording.
• Check for possible exclusions, pre-existing damage, or non-compliance with installation standards.
• Validate quotations and ensure they align with insurer-approved rates.
• Contact policyholders to explain the claims process, required documents, and next steps .
• Liaise with plumbers, assessors, and suppliers to schedule inspections or repairs.
• Provide claim status updates and manage expectations regarding timelines and approvals.
• Handle basic queries, escalate complex issues to senior claims handlers when necessary.
• Capture approved payments, including plumber call-out fees, replacement geyser costs, and reinstatement work.
• Ensure excesses are correctly applied and communicated to the client.
• Reconcile invoices and check for discrepancies before payment.
• Monitor turnaround times and follow up on outstanding reports or documents.
• Assist with logging supplier performance issues or delays.
• Support senior claims consultants with bulk claims during peak seasons (e.g., storms, winter).
• File, archive, and maintain claim records in line with compliance requirements.
• Adhere to internal claims procedures, SLA requirements, and regulatory standards.
• Flag suspicious or potentially fraudulent claims for further investigation.
• Ensure all communication and documentation meets audit and compliance standards.

• Capture new geyser claims on the system with accurate client, policy, and incident details.
• Verify policy status, cover type, excess amounts, and waiting periods before processing.
• Allocate claims to assessors, plumbers, or service providers based on location and urgency.
• Maintain updated claim notes, documentation, and correspondence on the claims platform.
• Request and review required documents such as photos, plumber reports, invoices, and proof of ownership.
• Confirm cause of damage (burst, leak, thermostat failure, corrosion, etc.) against policy wording.
• Check for possible exclusions, pre-existing damage, or non-compliance with installation standards.
• Validate quotations and ensure they align with insurer-approved rates.
• Contact policyholders to explain the claims process, required documents, and next steps .
• Liaise with plumbers, assessors, and suppliers to schedule inspections or repairs.
• Provide claim status updates and manage expectations regarding timelines and approvals.
• Handle basic queries, escalate complex issues to senior claims handlers when necessary.
• Capture approved payments, including plumber call-out fees, replacement geyser costs, and reinstatement work.
• Ensure excesses are correctly applied and communicated to the client.
• Reconcile invoices and check for discrepancies before payment.
• Monitor turnaround times and follow up on outstanding reports or documents.
• Assist with logging supplier performance issues or delays.
• Support senior claims consultants with bulk claims during peak seasons (e.g., storms, winter).
• File, archive, and maintain claim records in line with compliance requirements.
• Adhere to internal claims procedures, SLA requirements, and regulatory standards.
• Flag suspicious or potentially fraudulent claims for further investigation.
• Ensure all communication and documentation meets audit and compliance standards.

REQUIREMENTS:

• Grade 12
• Previous experience advantageous
• Customer Service and detail orientated
• Fully computer literate MS OFFICE

• Grade 12
• Previous experience advantageous
• Customer Service and detail orientated
• Fully computer literate MS OFFICE

REQUIREMENTS:

• Grade 12
• Previous experience advantageous
• Customer Service and detail orientated
• Fully computer literate MS OFFICE