Our claims department is looking for a Claims Administrator who has background experience in claims - specifically in funeral claims to process health and funeral claims as required. 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 captured -Liaise with the relevant affiliations to resolve issues around incorrect or incomplete documentation -Obtain additional or missing information -Provide accurate information to clients to provide excellent service -Conduct security checks before information is disclosed to clients -Follow-up and provide ongoing feedback to claimants and service providers until finalised -Escalate completed claim to the Claim Assessor for final processing -Escalate 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 instructions -Maintain strict compliance with company policies and regulatory requirements -Keep abreast of amendments to policy rules, benefit options, legislation, protocols, processes and systems -Undertake any other duties as determined by the business needs Essential Qualifications: -Matric Legal or Statutory Requirements: -Clear criminal record -Clear credit record Essential Experience: -Minimum 2 years in the insurance industry -Experience in customer care and service delivery -Funeral Claims processing experience -Health Claims experience Knowledge and Skills: -Computer Literate -Strong inter-personal skills -High standard of verbal and written communication skills Attributes: -Able to work with minimal supervision -Assertive and persistent -Analytical, with an eye for detail -Able to work effectively under pressure -Responsible self-accountable -Honest, Hardworking, and Humble
