Claims Administrator

Main purpose of the Job

Provides support to clients relating to claims and claim queries. Project a professional company image through customer/provider interaction.

Claims Administrator

• Accurate capturing of claims (80 claims per day minimum)
• Scanning and filing of paper claims
• Inform customers/providers regarding unclear/ incomplete invoices via appropriate methods (email and in writing/ telephonically)
• Answer calls and resolve claim queries within determined SLA
• Transfer customer calls to appropriate staff, where necessary
• Follow-up on customer/provider enquires not immediately resolved, within determined SLAs
• Complete call logs and reports
• Follow and adhere to claim processes, procedures and protocol
• Recognize, document and alert the supervisor of trends with processing of claims
• Focus on first call resolution as far as possible
• Explain products and update customer details in computer system.
• Answer WhatsApp chats with customer requests within the determined SLA
• Conduct outbound calls as and when required to ensure client is informed and updated on the progress/ status of the claim
• Improve client service experience, create engaged clients, and facilitate organic growth
• Manages tasks allocated through omni-channel platforms including WhatsApp.
• Handle complex and escalated client service issues
• Build/maintain rapid channel of communication to client in case of service-related issues and events
• Represent the “Voice of the Customer”
• Create a culture of Customer/Client Centricity
• Identify any potential errors or obstacles that may arise which might impact client experience and ensure this has been addressed and highlighted to Supervisor.
• Demonstrate the Oneplan Values and Culture in all engagements with both clients and internal stakeholders.
• Leverage team success to drive all initiatives and experiences with clients.
• Display leadership through your actions by accepting responsibility for daily deliverables and ensuring turnaround times are achieved.
• Maintain forward thinking and proactiveness by taking ownership of every interaction with the client and managing the clients queries from end-to-end to ensure a world class client service experience.
• Support cross-functional work areas targeted to resolve issues raised by clients.
• Proactively gather client feedback to optimise client experience

Claims queries

• Provide accurate and efficient To log every call/ query received/made (Connex/ notes OPA)
• Follow-up on customer enquiries not immediately resolved, within determined SLAs.
• Complete call logs and reports.
• Educate clients on claims process

Quality, Consistency and Compliance

• Maintain QA standard and ensure error rate does not exceed accepted variance
• Timeous answering of chats within specified SLA (5 minutes)
• Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
• All Email/WhatsApp interactions must be returned to the queue at the end of every shift.
• A Screenshot of your Connex interaction page needs to be sent to your line manager at the end of your shift. (Two screenshots, one with the interactions in your queue {If applicable} and one after you have transferred the interactions to the queue.)
• Clear Download History and Cache daily.
• Ensure that your recycle bin is empty.
• Ensure adherence to all relevant legislation and regulations as set out by the Company, FSCA, and the Financial Services industry

Work Collaboratively

• Build a culture of respect and understanding across the organisation
• Recognise outcomes which resulted from effective collaboration between teams
• Build cooperation and overcome barriers to information sharing, communication and collaboration across the organization
• Facilitate opportunities to engage and collaborate with internal and external stakeholders to develop joint solutions.

Minimum Academic, Professional Qualifications & Experience required for this position

• Grade 12 with English and a second language
• RE5 (preferred)
• 1-2 years working experience in hospital/medical aid or insurance claims processing would be highly advantageous
• Meet FAIS fit and Proper requirements
• In-depth knowledge of Health/ Pet Insurance

Behaviors

• Punctual
• Energy
• Passion
• Respect for others
• Honest and Fair
• Positive Attitude
• Client Focus
• Tenacity
• Achieves Results
• Team player

Essential

• Investigate Issues
• Problem Solving
• Building Relationships
• Communicating Information
• Showing Resilience
• Adjusting to Change
• Giving Support
• Processing Details
• Structuring Tasks
• Driving Success
• Prioritise Client Experience

Functional Competencies

• Literacy - Have excellent reading, writing and interpersonal skills
• Pc Literacy - In-depth knowledge of Word, excel, email and Internet
• Ability to respond according to TAT
• Client relationship management
• Maximise service performance
• Query resolution
• Build & develop client centric capabilities
• Deliver on client expectations
• Knowledge Sharing
• Driving excellence through client experience Driving excellence through client experience

Leadership

• Demonstrate honesty and integrity
• Strive for Client Centricity
• Be agile and have the ability to adapt to change
• Build relationships and trust
• Be an agent of change
• Collaborative
• Share your views

Information :

• Company : Oneplan Underwriting Managers (Pty) Ltd.
• Position : Claims Administrator
• Location : Sandton, Gauteng
• Country : ZA