Customer Experience & Complaints Specialist

Oneplan.co.za; Sandton; On-site; ZAR 360,000 - 480,000; Full time

Job summary

OnePlan Insurance in Sandton is seeking a Customer Experience & Escalations Specialist to join our Operations team. This role focuses on investigations of complex customer issues across health-related products, ensuring proper resolutions and preventing recurrence.

The ideal candidate will have 3+ years in insurance or financial services, strong problem-solving skills, and the ability to coordinate across departments to maintain accuracy and governance in policy and billing processes.

Qualifications

• 3+ years of experience in insurance, financial services, or policy administration.
• Strong investigative and problem-solving skills with attention to detail.
• Ability to handle complex escalations across multiple departments.

Responsibilities

• Investigating and resolving complex customer complaints and escalations.
• Identifying root causes and coordinating corrective action.
• Investigating premium discrepancies and payment allocation issues.
• Tracing payments that have not reflected against customer policies.
• Investigating and validating refunds and customer credits.
• Resolving complex invoicing queries, credit memos and account discrepancies.
• Managing specialist policy transactions including redates, cancellations, upgrades, downgrades and dependant changes.
• Supporting Short Term policy cancellations and associated premium/refund calculations.
• Correcting complex policy administration errors.
• Supporting Customer Care, Sales, Retentions, QA, Collections and Authorisations with escalated policy amendments.
• Ensuring every financial and policy correction is accurate, authorised and fully traceable.
• Identifying recurring system, process and training failures and helping the business prevent them from happening again.
• You'll work primarily across Q-Contact, Otobo, Hello Peter and related OnePlan and customer interaction platforms.

Skills

Investigative skills

Problem-solving

Attention to detail

Communication

Cross-department collaboration

Tools

Q-Contact

Otobo

Hello Peter

Job description

Are you passionate about customer service and helping people through meaningful interactions every day?

Oneplan Insurance is looking for professional, energetic, and customer-focused Customer Service Representatives to support our growing client base across:

• Health Insurance
• Gap Cover
• Pet Insurance

We’re Hiring | Customer Experience & Escalations Specialist

Vertical : Health

Are you the person people turn to when a customer issue is too complex for the normal process?

OnePlan is looking for a Customer Experience & Complaints Specialist to join our Operations team.

This isn't a traditional customer service role.

We're looking for someone who enjoys investigating complex problems, understanding what went wrong, fixing it properly and making sure it doesn't happen again.

You'll work across customer complaints, premium and payment discrepancies, refunds, invoicing, policy amendments and other complex escalations that require strong investigation, policy administration and problem-solving skills.

What you'll do

You'll take ownership of complex customer complaints and operational escalations from investigation through to final resolution.

Your responsibilities will include:

• Investigating and resolving complex customer complaints and escalations.
• Identifying root causes and coordinating corrective action.
• Investigating premium discrepancies and payment allocation issues.
• Tracing payments that have not correctly reflected against customer policies.
• Investigating and validating refunds and customer credits.
• Resolving complex invoicing queries, credit memos and account discrepancies.
• Managing specialist policy transactions including redates, cancellations, upgrades, downgrades and dependant changes.
• Supporting Short Term policy cancellations and associated premium/refund calculations.
• Correcting complex policy administration errors.
• Supporting Customer Care, Sales, Retentions, QA, Collections and Authorisations with escalated policy amendments.
• Ensuring every financial and policy correction is accurate, authorised and fully traceable.
• Identifying recurring system, process and training failures and helping the business prevent them from happening again.

You'll work primarily across Q-Contact, Otobo, Hello Peter and related OnePlan and customer interaction platforms

.

What we're looking for

Ideally, you'll have 3+ years' experience in insurance, financial services, policy administration, customer escalations or a similar environment.

You'll need:

• Excellent investigative and problem-solving skills.
• Strong understanding of premiums, payments, refunds and policy administration.
• Confidence working through complicated transaction histories.
• Exceptional attention to detail.
• Strong written and verbal communication.
• The ability to deal professionally with dissatisfied customers.
• Sound judgement and a strong sense of accountability.
• The ability to work across multiple departments to get an issue resolved.
• A customer-first mindset without compromising financial controls, policy rules or governance.