Claims Fulfillment Consultant

Express Employment Professionals Durban North; Durban; Sur place; ZAR 180 000 - 300 000; Plein temps

Résumé du poste

Express Employment Professionals Durban North is seeking a Claims Processing professional to authorize and resolve insurance claims within mandated productivity targets. The role requires effective use of the claims diary system and strong communication to address technical issues and customer concerns.

You will ensure correct application of policy wording, accurate payment processing to service providers, and timely reporting of claims with appropriate quotes.

Qualifications

• Matric
• Insurance related qualifications such as FETC Short Term Insurance NQF 4 and RE5.
• 5 years of Short Term Claims Insurance experience, preferably with Homeowners/Building experience.

Responsabilités

• Authorize and process claims within the set mandate and productivity targets.
• Communicate and resolve technical issues using available tools and systems.
• Manage customer complaints and resolutions, understand claim rejections and ensure compliant handling.
• Understand payments, apply rates correctly to service providers, and appoint providers as needed.
• Prepare and communicate reports/quotes to ensure prompt claims resolutions.
• Maintain fair treatment of customers and accurate interpretation of incident history and policy wording.
• Consult with Loss Adjusters when discussing technical details and escalate suspicious activity as required.

Formation

Matric, Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5

Description du poste

Claims Processing

Authorize claims within the set mandate and resolve all claims within the agreed productivity targets and turnaround times by utilizing the claims diary system effectively.

Apply and effectively communicate technical skills and resolve all technical issues using available tools and systems.

Demonstrate a clear understanding and execution of customer complaints and resolutions that must be maintained and exceeded, as well as a clear understanding of claim rejections.

Demonstrate a clear understanding of the management of claims handling that must be followed within the regulated agreements as specified by the relevant regulatory boards.

Ensure a clear understanding of all payments, the correct application of rates to be authorized to the service provider, and the correct appointment of service providers to the claims.

Demonstrate a thorough understanding of the report and quotes to communicate prompt claims resolution to the customer.

Practice and Promote Consistent Effective Relationship Building

Ensure that all Customers are treated fairly, you must have a clear understanding and accurate interpretation of the reported incident, claims history, and correct application of the policy wording.

When communicating technical detail to the Customer, Loss Adjusters to consult or debate the outcome of the claim, ensure lateral thinking and professional engagement with all parties.

Have an inquisitive and investigative mind to communicate and report suspicious activity to the next reporting level if further intervention is required.

Desired Experience & Qualification

Matric
Insurance related qualifications e.g. FETC: Short Term Insurance NQF 4, RE5
5 years Short Term Claims Insurance related experience, preferably with Homeowners/Building experience.