Business Claims Specialist

2 weeks ago


Johannesburg, Gauteng, South Africa Deka Minas (Pty) Ltd Full time

One of our leading clients offering comprehensive financial solutions that include bond pre-approvals, home loans, short-term insurance, life insurance and more through its various subsidiaries is looking to build their Dream team with the Right People.


JOB PURPOSE:


As Business Claims Specialist you will provide support to the Product Manager, reviewing claims from customers, negotiating settlements, negotiating insurance coverage and reviewing insurance cases.

ROLES & RESPONSIBILITIES

  • Design and implement various policies and procedures for claims.
  • Provide services to all business requirements and ensure optimal handling of all claims
and investigate all issues and provide training for all business units.

  • Evaluate all new claims and administer all data integrity data and manage communication
to safety department and monitor all claims.

  • Evaluate all business units' associate claims.
  • Monitor effectiveness of all programs and provide support to all open claim file reviews
and manage all payment cycle to ensure compliance to all contract requirements.

  • Analyze all claims to ensure optimal quality and prepare reports for various business units
and monitor all chargeback expenses and provide report to all clients and management.

  • Schedule all internal and external audits on all claims issues and supervise processing of
all billing issues.

prepare claims reports and evaluate all actuarial.

  • Analyse all claims and identify all risks and ensure processing of all claims as per
company policy.

  • Analysing current systems and suggesting improvements
  • Analytical understanding of statistics, analyse daily impact and trend analysis
REQUIRED SKILLS / EXPERIENCE & QUALIFICATIONS

Qualifications:

  • Grade 1
  • Full Qualifications (FAIS)
  • Completed CPD for registered categories for last fit and proper cycle
  • Must have successfully completed the RE5 qualification
Experience

  • Experience in short
- and or long-term insurance products

  • Minimum 6 years' experience in an Insurance call centre environment (with references)

Skills:

  • Specialist knowledge and skills with regards to Insurance policies/ procedures
  • Computer Literate (Excel, Word & Outlook)
  • Excellent verbal, written and numeracy skills
  • Excellent telephonic sales and service ability
  • Vernacular an advantage
  • Understand importance of confidentiality with regards to clients' financial information


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