Personal Lines Claims Manager at Nedbank

The Personal Lines Claims Manager will manage in-house claims and Third-Party Administrators with binder agreements authorised to process claims. Review any outsourced functions relating to personal lines claims including mandates. Collaborate on the Service Provider Panel and the Product development. Manage the reporting of average cost per claim targets, effective procurement utilisation, salvage, recoveries and authorisation of claims.

Job Responsibilities

• Refer high risk claims including multi-claimants and total lost to underwriting.
• Discuss proposed amendments to pricing models and new covers with Actuarial team based on claims experience.
• Build and maintain effective relationships with key stakeholders.
• Ensure compliance with underwriting guidelines.
• Quality monitoring and reporting on the selection of risks, classification and rating of risks.

• Managing the personal lines claims team (inhouse or outsourced).
• Identifying trends and recommending improvements - understanding the competitive landscape and client expectations.
• Ensure that procured service providers are utilised where applicable and cost, recoveries and salvage monitored, estimates and statuses are updated.
• Ensure that claim validations are being done in accordance with our mandate and the cover provided.
• Dealing with VIP clients, escalations and complaints.
• Risk management / self-identified risks as well as be part of the team who deals with auditors and other monitoring teams.
• Authorising claims and approving rejections.
• Reporting daily/weekly/ monthly - for the Claims pack to the Ops Manco.
• Adhering to binder claims mandates. Process all claims over partial binder mandate.
• Evaluate and investigate all claims received in order to prevent possible leakage to the company in the settlement of claims.
• Monitor claims SLA and ensure that transactions are processed within delegated authority limites and within set standards.
• Detection and management of fraud, dishonesty, misrepresentation.
• Work with the NI Claims Manager to roll out of the claim's philosopy and framework within team and binder holders.
• Managing rejections, ex-gratia claims (be part of the committee chaired by the NI Claims Manager) and ensuring fairness and diplomatic communication.
• Coordination of third-party recover/liability claims.
• Ad-hoc projects when required. Technical advice and other assistance over and above the normal claim's duties.
• Customer service: Maintain a high level of service to customers (internal and external) according to the service standards as set by the company.
• Effective communication: Communicate effectively with external parties as well as claims team and other departments.
• Reporting: Weekly - Management reports; Outstanding Claims; Urgent claims report - status update, reserve limits; rejected claims.
• Reporting: Monthly - Insurer reports; KPI feedback; Standard operating Procedure review; Internal audit feedback

People Specification

Essential Qualifications - NQF Level

• Matric / Grade 12 / National Senior Certificate
• Advanced Diplomas/National 1st Degrees

Preferred Qualification

• Matric / Grade 12 / National Senior Certificate (non-negotiable)
• Higher Certificate in Insurance or equivalent / Degree (non-negotiable)

RE Qualification

Type of Exposure

• Managing a team of managers
• Building a community of leaders
• Developing a departmental strategic plan
• Developing resource plans to execute functional strategies
• Developing a client service delivery plan
• Formulating and implementing communication strategies to cascade functional strategies
• Conducting benchmarking exercises to investigate improvement opportunities
• Executing major organisational change
• Establishing and maintaining collaborative relationships with peers / subordinates / managers

Minimum Experience Level

A minimum of 10 years’ experience working in a Personal Lines industry, with at least 5 years’ claims experience including:

• Claims procedures and knowledge
• Underwriting procedures and Risk management
• Reinsurance and treaties
• Product knowledge
• Financial knowledge
• Salvage
• Third Party & Recoveries
• Knowledge of insurance practices
• Knowledge of personal line product benefits (Property, Motor, Personal Accident & Liabilities)
• Sound understanding of the TCF / Market Conduct principles
• 3 years management experience advantageous

Technical / Professional Knowledge

• Business administration and management
• Business terms and definitions
• Communication Strategies
• Financial Accounting Principles
• Insurance/risk management procedures
• Relevant regulatory knowledge
• Stakeholder management
• Short Term Insurance
• Governance, risk and controls

Behavioural Competencies

• Customer Focus
• Facilitating Change
• Influencing
• Inspiring others
• Guiding Team Success
• Continuous Improvement
• Driving for Results