Claims Administrator

Claims Administrator

Accurate capturing of claims (80 claims per day minimum)
Scanning and filing of paper claims
Inform customers/providers regarding unclear/ incomplete invoices via appropriate methods (email and in writing/ telephonically)
Answer calls and resolve claim queries within determined SLA
Transfer customer calls to appropriate staff, where necessary
Follow-up on customer/provider enquires not immediately resolved, within determined SLA’s
Complete call logs and reports
Follow and adhere to claim processes, procedures and protocol
Recognize, document and alert the supervisor of trends with processing of claims
Focus on first call resolution as far as possible
Explain products and update customer details in computer system.
Answer WhatsApp chats with customer requests within the determined SLA
Conduct outbound calls as and when required to ensure client is informed and updated on the progress/ status of the claim
Improve client service experience, create engaged clients, and facilitate organic growth
Manages tasks allocated through omni-channel platforms including WhatsApp.
Handle complex and escalated client service issues
Build/maintain rapid channel of communication to client in case of service-related issues and events
Represent the “Voice of the Customer”
Create a culture of Customer/Client Centricity
Identify any potential errors or obstacles that may arise which might impact client experience and ensure this has been addressed and highlighted to Supervisor.
Demonstrate the Oneplan Values and Culture in all engagements with both clients and internal stakeholders.
Leverage team success to drive all initiatives and experiences with clients.
Display leadership through your actions by accepting responsibility for daily deliverables and ensuring turnaround times are achieved.
Maintain forward thinking and proactiveness by taking ownership of every interaction with the client and managing the client’s queries from end-to-end to ensure a world class client service experience.
Support cross-functional work areas targeted to resolve issues raised by clients.
Proactively gather client feedback to optimise client experience

Claims queries

Provide accurate and efficient To log every call/ query received/made (Connex/ notes OPA)
Follow-up on customer enquiries not immediately resolved, within determined SLA’s.
Complete call logs and reports.
Educate clients on claims process

Quality, Consistency and Compliance

Maintain QA standard and ensure error rate does not exceed accepted variance
Timeous answering of chats within specified SLA (5 minutes)
Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
All Email/WhatsApp interactions must be returned to the queue at the end of every shift.
A Screenshot of your Connex interaction page needs to be sent to your line manager at the end of your shift. (Two screenshots, one with the interactions in your queue {If applicable} and one after you have transferred the interactions to the queue.)
Clear Download History and Cache daily.
Ensure that your recycle bin is empty.
Ensure adherence to all relevant legislation and regulations as set out by the Company, FSCA, and the Financial Services industry

Work Collaboratively 

Build a culture of respect and understanding across the organisation
Recognise outcomes which resulted from effective collaboration between teams
Build cooperation and overcome barriers to information sharing, communication and collaboration across the organization
Facilitate opportunities to engage and collaborate with internal and external stakeholders to develop joint solutions.

Minimum Academic, Professional Qualifications & Experience required for this position

Grade 12 with English and a second language
RE5 (preferred)
1-2 years working experience in hospital/medical aid or insurance claims processing would be highly advantageous
Meet FAIS fit and Proper requirements
In-depth knowledge of Health/ Pet Insurance

Apply via company website ( N / A ) or

eplan.mcidirecthire.com