Claims Processing Consultant: (Afrikaans)

Telesure Investment Holdings (TIH); Johannesburg; On-site; ZAR 180,000 - 240,000; Full time

Job summary

TIH is seeking a Claims Administrator to capture and process VAPS claims, ensuring standardised decision making and timely resolution for customers. You will collect data, analyse information, and cost claims while maintaining documentation and responding to inquiries.

The role involves managing schedules, producing best-practice support, and identifying opportunities to upsell relevant products or services in a compliant manner.

Qualifications

• Matric/Grade 12 or SAQA equivalent is essential.
• Regulatory exam 5 is advantageous.

Responsibilities

• Capture and process claims using established criteria to standardise decisions.
• Manage customer requests and provide timely feedback.
• Analyse data, collect information from sources, and cost claims.
• Schedule work to meet SLA and maintain knowledge of products and policies.
• Prepare and manage claim documentation and correspondence.
• Respond to inquiries via phone or email and maintain records.
• Organise and maintain claim files and documents in the system.
• Identify upsell opportunities and explain product/service benefits.

Education

Matric / Grade 12/ SAQA Accredited Equivalent

Regulatory exam 5 (Advantageous)

Job description

Join TIH, home to some of South Africa’s leading financial service providers, and grow your career while being part of an organisation with purpose.

Job Purpose

Capture and process VAPS claims efficiently and accurately through drawing on the relevant criteria to ensure standardisation across the organisation to enable decision making on a claim.

Responsibilities

Customer Management (Internal)

Help manage customer by carrying out standard activities to complete the customer request.

Data Collection & Analysis

Ask questions, collect data from a variety of sources, analyse information and investigate claim. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools (supplier contract and/or negotiation) to accurately cost applicable claims on a day-to-day basis.

Work Scheduling and operational compliance

Organise own work schedule in order to get the job done, coordinating with support services and completed work within SLA. Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately). Remain up to date with current and new product knowledge to enable effective decision making.

Administration

Produce, update and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.

Correspondence

Respond to routine requests using telephonic conversation or emails (internal and external). Ensure regular feedback to customer, service providers and other stakeholders, as determined by the company and/or customer requirements to ensure customer receives appropriate feedback from the claim department.

Document Management

Create, organise and maintain files containing the correspondence relating to policies and matters and claims to be uploaded on internal system.

Document Preparation

Prepare and manage claim documentation for customers.

Up-sell Customer Propositions

Identify a selection of products or services that may meet the customer's requirements, explain the product/service features influence the customer to add additional products/services.

Education

Matric / Grade 12/ SAQA Accredited Equivalent (Essential); Regulatory exam 5 (Advantageous)

Experience

0-1 year experience, especially client services – which includes capturing applications, instructions, reporting, and attending to IFA and client queries (Essential); Experience in the Financial Services environment (Advantageous)

Additional

Think you have what it takes to be part of an unstoppable team who constantly finds better ways to give peace of mind?