Job Summary:
Accurately assess Pet Insurance claims submitted for Veterinary facilities. Provide support and education to clients and appropriate vendors/providers relating to claims queries, processes, and the policy. Project a professional company image through omni-channel interaction.
Key Duties & Responsibilities:
- Claims Assessing:
- Timeous and accurate assessing of claims (30 claims per day minimum).
- Assist when additional help is needed on queues to keep them live, assist with overflow as directed by team leader and/or supervisor.
- Authorization of Hospital claims as per policy terms and conditions.
- Inform customers/providers in a professional manner regarding invoices that will not be accepted or specific claim requirements.
- Follow-up on customer/provider inquiries not immediately resolved, within determined SLA’s.
- All client communication to be professional and accurate.
- Answer phones and respond to customer requests within the determined SLA.
- Explain products and update customer details in the computer system.
- Provide customers with product and service information via appropriate methods.
- Follow and adhere to claims/company processes, procedures, and protocol.
- Recognize, document, and alert the supervisor of trends in customer calls/claims.
- Recommend process changes and/or improvement suggestions.
- Focus on first call resolution as far as possible.
- Answer WhatsApp chats with customer requests within the determined SLA.
- Transfer customer calls to appropriate staff, where necessary.
- Conduct outbound calls as required to ensure the client is informed and updated on the progress/status of the claim.
- Ensure daily stats are manually tracked and updated on the daily spreadsheet.
- Assess claims according to standard operating procedure and company protocols.
- Improve client service experience and create engaged clients.
- Handle complex and escalated client service issues.
- Identify any potential errors or obstacles that may arise which might impact client experience.
- Demonstrate the Oneplan Values and Culture in all engagements.
- Display leadership through your actions by accepting responsibility for daily deliverables.
- Support cross-functional work areas targeted to resolve issues raised.
- Underwriting:
- Pet image validation- queue to be cleared daily.
- Request regularly for updated pet images.
- Accurately Underwriting of new dependents according to protocol.
- Additional tasks:
- Be available and willing to assist with any additional tasks and projects as required.
- Conduct outbound calls to ensure client is informed and updated on the progress/status of the claim.
- Claims Queries:
- Log every call/query received/made.
- Identify, research, and resolve customer issues using the CRMS.
- Complete call logs and reports.
- Educate clients on claims process and general claims queries.
- Assist and resolve claim queries and client complaints.
- Quality, Consistency, and Compliance:
- Maintain standards as per CSAT, QA Call metrics, and claim assessing score.
- Timeous answering of chats within specified SLA.
- Deliver quality service by providing efficient, quick, and friendly service to clients.
- Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge.
- Work Collaboratively:
- Build a culture of respect and understanding across the organisation.
- Facilitate opportunities to engage and collaborate with stakeholders.
- Self-Management and Time Management:
- Demonstrate consistent application of internal procedures.
- Plan and prioritise, demonstrating abilities to manage competing demands.
- Demonstrate flexibility in balancing achievement of objectives.
Key Requirements of the Role:
- Grade 12 with English and a second language.
- RE5 (preferred).
- Relevant qualification in a related field advantageous.
- Minimum of 2-3 years Customer Service and Claims experience (preferably Pet Insurance).
- Meet FAIS fit and Proper requirements.
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