Claims Professional Services Agent

This role will be responsible to ensure that the reporting staff members understand and satisfy the customer requirements and will create a culture of service.

All claims documents, queries, and financial assessments must be accurately done and within SLA. The focus is to deliver high standards of service to members.

The role involves accurately capturing and processing key claims-related information to ensure thorough and efficient claims assessment.

It requires clear and professional communication of essential details to stakeholders such as claims assessors, members, advisers, and internal teams.

Additionally, the role includes addressing and resolving claims-related queries, maintaining a high level of accuracy, attention to detail, and adherence to service level agreements (SLAs).

Acting as a central point of contact, the role supports smooth claims processes and fosters positive relationships with stakeholders to ensure an exceptional service experience. Must be able to work shifts (11pm – 7am, 3am – 11pm, 12 am – 8am, and 4am – 12am – times are subject to change).

Formal Qualifications

Matric
3-year tertiary qualification (Degree / Btech / Nat Dip) with relevance to business orientation essential.

Experience

2 - 3 years' experience in claims and / or administrative and business coordinating / business sales support role in financial services essential.
2 - 3 years intermediate knowledge of the Life Assurance or Financial Services industry essential.
Knowledge of customer services and claims operations environment.
Must consistently meet deadlines and service commitments.

Knowledge and Skills

1. Strong networking and relationship building (Internal & external).
2. Service-driven, with a focus on accuracy and quality of information delivered within service levels.
3. Strong attention to detail.
4. A strong work ethic and a drive to exceed expectations.
5. Strong analytic and problem-solving skills.
6. Adaptability to different stakeholders, audiences, and environments.
7. Effective use of MS Office applications (Outlook, Visio, Word, Excel, PowerPoint, Projects).
8. Time Management.
9. Adapting and responding to change.
10. Business Acumen.
11. Deciding and Initiating Action.

Interpersonal and Intrapersonal Skills

1. Problem solving.
2. Customer focus - Be a fast thinker with excellent conflict resolution skills to deal with both irate and complimentary members / intermediaries.
3. Customer-centric and display a positive and professional image of PPS by building and maintaining relationships.
4. Have excellent verbal and written communication skills in English.
5. A good command of the English Language.
6. Be a team player by being reliable and trustworthy.
7. Be proactive and have an ability to solve problems.

Duties and Responsibilities

1. Operations Management: Quality assurance of claims documents.
2. Reviewing of documents received, accurate checks to be done for claims, completeness of documentation.
3. Ensure standard requirements have been met for the claims to be finalized and request for outstanding information.
4. Updating of information on Service Manager.
5. Ensure that details are captured accurately on the system: Banking details update as per Electronic Funds Transfer Authority form.

Administrator Performance: The performance of individuals is essential to the success of a Claims Admin team.
Process Optimization and Efficiencies: Duties include working with cross-functional teams to deliver exceptional service to all stakeholders.
Cultivate a performance-driven team collaborating with support and other operational teams.

Policy: We are committed to Employment Equity when recruiting internally and externally. It is company policy to promote from within wherever possible. Therefore, please be aware that internal candidates will be considered first before reviewing external applicants, provided that this supports the achievement of our Employment Equity goals.

Based on the nature of our business, honesty and integrity are essential qualities for our positions.