JOB PURPOSE
Process already-captured claims efficiently and accurately through drawing on the relevant criteria to ensure standardisation across the organisation to enable decision making on a claim.
Responsibilities
Customer Management (Internal)
Help manage customer by carrying out standard activities to complete the customer request.
Data Collection & Analysis
Ask questions, collect data from a variety of sources, analyse information and investigate claim. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools (ITC, supplier contract and/or negotiation) to accurately cost applicable claims on a day-to-day basis.
Work Scheduling and operational compliance
Organize own work schedule in order to get the job done, coordinating with support services and completed work within SLA. Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately). Remain up to date current and new product knowledge to enable effective decision making.
Administration
Produce, update, and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.
Correspondence
Respond to routine requests using telephonic conversation or emails (internal and external). 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.
Document Management
Create, organize, and maintain files containing the correspondence relating to policies and matters.
Document Preparation
Prepare and manage claim documentation for customers.
TECHNICAL COMPETENCIES
Verbal Communication
Uses clear and effective verbal communications skills without supervision and provides technical guidance when required on expressing ideas, requesting actions and formulating plans or policies.
Numerical Skills
Uses an understanding of numerical concepts to perform mathematical operations such as report analysis with guidance (but not constant supervision).
Computer Skills
Supports business processes without supervision by understanding and effectively using standard office equipment and standard software packages, while providing technical guidance as needed. Basic computer skills; Microsoft Office Basic.
Planning and Organizing
Works without supervision and provides technical guidance when required on planning, organizing, prioritizing, and overseeing activities to efficiently meet business objectives.
Policy and procedures
Works with guidance (but not constant supervision) to develop, monitor, interpret and understand policies and procedures, while making sure they match organizational strategies and objectives.
Knowledge of claims policy and procedures.
Action Planning
Works with guidance (but not constant supervision) to develop appropriate plans or perform necessary actions based on recommendations and requirements.
Data Collection and analysis
Works under guidance to analyse data to critically evaluate information to ensure accuracy of content.
Internet browser knowledge
Applies concepts of knowledge / skill without requiring supervision; also, able to provide technical guidance when required.
EDUCATION
- General Education Matric / Grade 12/ SAQA Accredited Equivalent (Essential)
- Regulatory exam 5 (Essential)
General Experience
- 1-3 years Financial Services industry experience (Essential)
- STI experience and commercial/ business insurance (Advantageous)
- Prepare insurance claim forms or related documents and review them for completeness.
- Enter claims information into database systems.
- Calculate amount of claim
- Post or attach information to claim file.
- Contact insured or other involved persons to obtain missing information.
- Review insurance policy to determine coverage.
- Organize or work with detailed office records, using computers to enter, access, search or retrieve data.
- Organize or work with detailed office records, using computers to enter, access, search or retrieve data.
- Finalise claims and send to services department.
- Listen and transcribe client conversations.
- Request Client Conversation
- Retrieve Client Conversation
- Issue repair / replace vouchers.
- Load and action 15-minute messages.
- Complete TTDs and requests
