Claims Administrator - Funeral

Affinity Health; Johannesburg; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A health insurance provider in Johannesburg is seeking a Claims Processor to manage claims effectively. Responsibilities include processing claims, engaging with members and service providers, and performing general administrative tasks. The ideal candidate should have at least 2 years of experience in the insurance industry, excellent communication skills, and be computer literate. This position offers a dynamic work environment in the healthcare sector.

Qualifications

• Minimum 2 years in the insurance industry.
• Experience in customer care and service delivery.

Responsibilities

• Process, and Capture, Claims Information.
• Engage With Members / Claimants and Service Providers Regarding Queries.
• Perform General Administrative Tasks.

Skills

Computer Literate

Strong inter-personal skills

High standard of verbal and written communication skills

Education

Matric

Job description

Responsibilities

• 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
• Essential Experienc
• Minimum 2 years in the insurance industry
• Experience in customer care and service delivery

Knowledge and Skills

• Computer Literate
• Strong inter-personal skills
• High standard of verbal and written communication skills