Gap Claims Specialist

Kaelo; KwaZulu-Natal; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A leading insurance firm is seeking a Claims Specialist to manage claim assessments and ensure exceptional customer service. The role focuses on accurate claims processing, resolving client queries, and contributing to process improvements. Candidates need insurance industry experience and relevant qualifications, including FAIS/RE5. This position requires strong administrative and communication skills.

Qualifications

• Insurance industry experience is required.
• Health insurance industry experience is preferred.
• Matric is required.
• FAIS/RE5 qualification is required.
• FAIS/RE5 accreditation with a minimum of 120 credits is preferred.

Responsibilities

• Process claims accurately and efficiently.
• Support other divisions as required.
• Make continuous improvements in processes.
• Ensure claims are processed within turnaround time.
• Assist clients with queries.
• Complete administrative tasks daily.
• Handle telephonic queries from various stakeholders.
• Provide ongoing feedback to clients.

Tools

Microsoft Access

Job description

Overview

The Claims Specialist manages the assessment of claims and has specialised knowledge of the claims environment. There is a strong focus on accurately and efficiently resolving the claim received whilst ensuring exceptional customer service and satisfaction

Key Outcomes

• The accurate and efficient processing of claims captured
• Ad hoc duties- support in the operation of other divisions
• Contribute towards continuous improvement and innovation at process and procedure level
• To ensure that all claims processing and queries are attended to accurately and within the agreed turnaround time
• Contribute toward risk management
• Assist clients with queries and provide suitable query resolution
• Accurate completion of administrative targets on a daily basis
• Dealing with multiple telephonic queries from members, brokers and franchises
• Ongoing feedback to clients
• Ad hoc functions as required by Management

Qualifications

Required

• Insurance Industry Experience

Preferred

• Health Insurance Industry Experience

Education, Qualifications and Accreditation with Professional Body

Required

• Matric
• FAIS / RE5

Preferred

• FAIS / RE5 Accreditation with minimum 120 credits

Technical Skills or Knowledge

Required

• Computer Literate incl. Microsoft Access

Additional Information

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated