Nombulelo Motsei

•Ability to balance claim investigations with treating customers fairly(TCF).

•Working within a team environment to identify and tackle fraudulent claims as well as assessing and verification within a team environment to identify and tackle fraudulent claims as well as assessing and verification of Desktop Non-motor claims.

•Handling a portfolio of suspected claims which would encompass all types of fraud.

•Conduct a Merit and Quantum claim validation for non-motor claims.

•Identify fraud indicators and gathering information.

•Validating policy coverage and decide the appropriate action.

•Case ownership to deal with claims from beginning to end.

•Accountable for all claim interactions directly with the client/broker.

•Ensures that the claim is handled efficiently.

•Communicate the process from the start of the claim and act as contact person if the client needs more information.

•Monitoring of work load and keep within the required SLA Turnaround times.

•Administer and validate claims correctly and efficiently within
the specifications of the company’s terms and conditions.
• Render a claims related service within turnaround time that is
acceptable to customers and conforms to company SLA’s.
• Investigate claims to determine merits for pay-outs.
• Interview all parties involved to gather information on the
claims process from start to end.
• Desktop Adjustment/Investigation of claims.
• Make critical claims technical decisions in line products and
procedures.
• Update claims and estimates on the system.
• Manage a diary of the workflow and deadlines for information
and service.
• Make payments as required.
• Maintain a good relationship of co-operation, feedback and
client experience to brokers and service providers. This
includes telephonic and written correspondence.
• On-site and face to face meetings with clients, brokers and
service providers.
• Liaise with repairers in resolving assessing and repair queries.

• Ensure claims are finalized within the set parameters(turnaround time, terms and conditions
Applied accurately)
• Ensure regular feedback to services department and other stakeholders, as determined by the company and/or customer requirements to ensure customer receives appropriate feedback from the services department.
• Use appropriate tools (ITC, supplier contract and/or negotiation) to accurately cost applicable claims on a day to day basis.