Description du poste

Duties & responsibilities

To efficiently administer, investigate and process claims, handle and resolve complaints for PPI business, answer customer phone calls, implementing streamlined processes and procedures and provide business support on all operational aspects within your team and your department. This job description relates to all partnerships.

Claims:

• Assess and process claims within the PPI portfolio according to relevant policy terms and conditions
• Process and decision claims over the delegation for all businesses based on recommendation received from TPA and according to the relevant policy terms and conditions. Confirm approval to TPA
• Check monthly reporting per partner for its accuracy and completeness
• Check Claims transfer request forms and sign off monthly/weekly confirming accuracy
• Maintain an individual internal quality level > 95% on a monthly basis

Complaints:

• Log all customer complaints sent directly to CACI Life/Non-Life or indirectly via TPA using Respond System
• Review the complaint and process same within delegation authority. For cases above the delegated authority, prepare a recommendation for sign off via escalation route according to complaints procedure
• Analyse and report all third level complaints internally
• Coordinate, monitor and report all legal complaints/summons following the complaint procedure

Customer Service (if applicable):

• Answer customer service telephone calls as part of the call center roster when requested to do so
• Maintain call accepted rate within SLA
• Ensure calls are answered within SLA
• Ensure timely follow up is completed on all post call administration
• Ensure quality answers are provided to customers and a level of professional response is provided at all times

Business support:

• Assist in creating and updating claims and subscriptions procedures as and when necessary, for new and existing business
• Assist the Supervisor in insuring that all business documentation for the department is up to date, filed and archived
• Present suggestions for reviewing and updating procedures to Supervisor and implement, coordinate, and monitor any upgrades to procedures as they are signed off
• Provide training both internal & external
• Maintain various regular and ad hoc reports and provide to your Supervisor
• Perform other work or projects as and when selected by the Operations Supervisor or Operations Manager

Partner Management:

• To provide customer service support for the business portfolios according to SLA
• Travel on Operational visits to partners with Supervisor/ Operations Manager ensuring prior organization by means of Agenda and Minutes to be circulated on return
• Liaise with all partners in order to provide follow-up trainings and clarification on operational queries, understanding of policy wording and/or working processes via conference calls or emails
• Relationship building and ongoing management is a large part of this role
  
  

Complément

Projects:
Participate in any projects related to your market including but not limited to – new product implementation and ongoing administering, new partnership implementation and ongoing administering
Training related to day to day business, training of new partnerships, new product training internally within the team/department or within the partnerships
INTERFACE:
Insurance Division: Dublin Management Team and Insurance Division in France (Administration, Business Development and other services)
Group: Group claims & subscriptions departments
External: Partners in Europe: Finance Companies & TPA