Financial Lines, Senior Claims Examiner

Main Purpose:
The primary purpose of this role is to produce a high quality work product on a portfolio of intermediate to complex claims through immediate contact and the effective investigation, reserving and adjustment of claims incurred by insureds or third parties.
Major duties/responsibilities are detailed in the individual's annual goals. These goals may include items such as:
Manage a portfolio of financial lines claims in accordance with Best Practice Guidelines.
Analyse first report to determine nature of loss, coverage provided and scope of injury/damage.
Conduct investigations of all aspects of reported claims including potential fraud. Secure and/or file all supporting documentation and verify same for accuracy, relationship and completeness.
Establish accurate and timely reserves.
Provide exceptional service standards in line with best practice guidelines
Maintain an active diary. Monitor same to achieve timely development of the file and timely disposition of the claim.
Promptly and properly document all developments on claim workstation file.
Exercise good judgement in reaching final disposition of claim by evaluating nature of loss, liability, injury/damage, coverage provided and applicable limits.
Effectively negotiate compromise settlements where appropriate.
Effectively communicate with the following: claim department, customer services, loss control, underwriting departments, finance departments, brokers, insureds, service providers, third parties and/or their legal representatives.
Recognise and pursue subrogation where applicable.
Adhere to Insurance Contracts Act, the Insurance Code of Practice and all other relevant statutory rules and regulations.
Effectively control the use, work product and expense of outside vendors.
Effectively present cases at claims committee.
Any other duties as required by the Claims Manager.
Experience & Skills
Relevant Tertiary or Insurance Industry Qualifications
Minimum of 3 years financial lines claims experience
Broad knowledge of insurance industry and claims processes
Written and verbal communication skills
Workflow management skills
Strong customer service focus
Proven team player

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