Key Tasks
Process, and Capture, Claims Information
Respond to members / claimants and request all required documents.
- Validate policy status, nominated dependants and beneficiaries
- Confirm policy terms and conditions are met. (e.g. waiting periods, general exclusions)
- Check that all claim documentation is accurate, complete and compliant with protocols, processes and relevant legislation
- Clarify details regarding claims (both verbal and written)
- Capture relevant claim information (e.g., approved documents and claim related notes) on the appropriate platform (e.g., funeral claim register)
- Process claims accurately
Engage With Members / Claimants and Service Providers Regarding Queries
Check that all applicable documents are received and capturedLiaise with the relevant affiliations to resolve issues around incorrect or incomplete documentationObtain additional or missing informationProvide accurate information to clients to provide excellent serviceConduct security checks before information is disclosed to clientsFollow-up and provide ongoing feedback to claimants and service providers until finalisedEscalate completed claim to the Claim Assessor for final processingEscalate any red flags / discrepancies, if identified, to the Claims Assessor.Perform General Administrative Tasks
Uphold tight SLA adherence throughout the entire claims processing activity.Maintain strict adherence to all verbal or written instructionsMaintain strict compliance with company policies and regulatory requirementsKeep abreast of amendments to policy rules, benefit options, legislation, protocols, processes and systemsUndertake any other duties as determined by the business needsEssential Qualifications
Matric
Essential Experienc
Minimum 2 years in the insurance industry
Experience in customer care and service deliveryKnowledge and Skills
Computer Literate
Strong inter-personal skillsHigh standard of verbal and written communication skills