Claims Specialist; Marine

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Santam Marine has a career opportunity for a Claims Specialist in the Claims department which will be based in Gauteng.

The successful candidate will manage a complex portfolio of claims from notification to closure, investing the necessary level of involvement required for each claim depending on, inter alia, the nature, category, maturity, type and quantum of the claim. This includes but are not limited to:

• Ensure correct segmentation of claims to claim handlers based on their mandates and their technical skill set
• Assist with continuous training of Team Members in accordance with Legal Developments and new products being offered
• Always follow Santam Marine Claims Reserving Philosophy and Claims Standards.
• Develop, iterate, document and execute claims strategies considering uncertainties, key decisions, potential outcomes and estimated associated costs.
• Understand and implement Santam Marine’s “Treating Customers Fairly” policy.
• Understand and execute the requirements set out by the Internal Osti and Client Liaison division for complaints within the ethos of Santam Groups Claims Framework.
• Manage claims portfolio(s) to optimise performance including:
• Regularly review individual claims within the portfolio and keep reserves and records up to date as required by Santam Marine claims controls and standards.
• Identify issues and trends in the portfolio and take appropriate and/or corrective action.
• Ensure that all claims rejections are referred to Management for discussion before submission to Client.
• Demonstrating thorough and sound application of policy knowledge to claims.
• Display fair legal understanding in dealing with technical complex claims.
• Deal with complaints internal and external (OSTI) complaint, and elevate accordingly
• Escalate problem claims to team leader, senior claims specialist and management (summons/brand and or reputational damage/complaints and near miss losses)

Working with Underwriters

• Develop an understanding of marketing and underwriting strategies for your business area and contribute to business development and renewal opportunities by attending client meetings to explain the Santam Marine claims philosophy and approach to claims handling and discussing any claims issues.
• Provide input to underwriters on review of potential or existing insured’s claims experience.
• Provide feedback on claims trends and developments and their potential impact on the book. Collaborate with the marketing and underwriting regarding grey areas on policy wordings.
• Collaborate with the marketing and underwriting regarding grey areas on policy wordings.
• Authority and Minimum Standards Observance
• Operate within your approved claims authority at all times.
• Implement minimum operating and claim standards.
• Have thorough knowledge of industry regulations and minimum standards to ensure compliance with the regulations and Santam Marine claims and underwriting control standards and protocols.

Third party Management

• Follow Santam Marine claims procedures for the selection and retention of third-party professionals and manage these relationships to the benefit of Santam Marine claims.
• Where required conduct claim file reviews or audits and resolve any issues identified.

Broker and Insured Relations

• Work proactively to develop and manage strong relations with key brokers and insureds.
• Promote the Santam Marine brand of excellence and professionalism in client service.
• Updates and follow-ups with Brokers and Surveyors.
• When required, provide Broker with Loss Ratio Reports.
• Where required attend meetings with Relationship Managers, ensure that the Claims Manager is included.
• Claim Specialist and Claim Handler’s should not attend to meetings without a team leader and/or management.

Conflict of Interest

• Adhere to Santam Marine Conflicts of Interest policy, alert the appropriate person to any potential conflicts of interest and take steps to resolve them promptly.
• Immediately advise Head of Department if any Santam Marine Claims employee seeks to exert undue influence on…