Claims Administrator

Oneplan Underwriting Managers Ltd; Johannesburg; On-site; ZAR 200,000 - 300,000; Full time

Job summary

Une entreprise dynamique dans le secteur des assurances recherche un Administrateur de Réclamations pour gérer efficacement les demandes et améliorer l'expérience client. Le candidat idéal aura un bagage en service client et une connaissance approfondie du traitement des réclamations d'assurance, avec une attention particulière à la qualité et à la conformité. Cette opportunité offre un environnement de travail engageant avec des perspectives de croissance.

Qualifications

• Compétences en communication et service client.
• Connaissances en traitement des réclamations d'assurance.
• Expérience souhaitée de 1 à 2 ans dans un environnement d'assurance.

Responsibilities

• Capturer les réclamations avec précision.
• Répondre aux appels et résoudre les requêtes des clients.
• Assurer le respect des processus et protocoles de réclamation.

Skills

Service Client

Organisation

Communication

Education

Grade 12 avec anglais et une deuxième langue

Job description

Job Location : Gauteng, Johannesburg Deadline : July 03, 2025 Quick Recommended Links

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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
• 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
• 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