Vacancy Details
Employer: National Risk Managers ( Affinity Health)
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
Candidate Requirements
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
123 people have applied for this job. 1125 people have viewed this job.
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