Claims Administrator

2 weeks ago


Kempton Park, South Africa CoetzeeHR Consultants Full time

**Duties & Responsibilities**
- Claim Processing: Accurately and efficiently process claims submitted by clients or policyholders according to established procedures and guidelines.
- Documentation and Record-Keeping: Maintain comprehensive and organized claim files, including all relevant documents, correspondence, and notes related to each claim.
- Verification and Investigation: Review and verify claim information, ensuring accuracy and completeness. Conduct necessary investigations and gather supporting documentation as required.
- Communication: Serve as the primary point of contact for clients, policyholders, and external stakeholders regarding claim status updates, requests for additional information, and general inquiries. Provide exceptional customer service and ensure timely and professional communication at all times.
- Claims Evaluation: Assess and evaluate claims based on policy terms, coverage, and applicable regulations. Collaborate with adjusters or other professionals to obtain necessary information for claim assessment.
- Data Management: Maintain accurate and up-to-date records of claim activities, payments, and reserves using internal systems or databases. Generate reports as needed.
- Compliance: Adhere to company policies, industry regulations, and legal requirements throughout the claims process. Ensure confidentiality and data protection of sensitive information.
- Claim Settlement: Collaborate with the claims team to facilitate prompt and accurate claim settlements. Process approved payments and coordinate with relevant parties, such as finance or legal departments.
- Continuous Improvement: Identify opportunities for process improvements and suggest innovative ideas to enhance efficiency, accuracy, and customer satisfaction in claims administration.
- Training and Support: Provide guidance and assistance to other team members as needed. Participate in training programs to stay updated on industry trends, best practices, and relevant software tools.

**Desired Experience & Qualification**:

- Matric certificate - not negotiable.
- Diploma or equivalent; additional certification or coursework in insurance, claims administration, or a related field (advantage).
- Proven experience in claims administration, insurance, or a similar role is preferred.
- Familiarity with insurance policies, coverage terms, and claims processes.
- Strong attention to detail and ability to maintain accuracy in a fast-paced environment.
- Excellent organizational and time management skills, with the ability to prioritize tasks effectively.
- Proficient computer skills and experience using claims management software or databases.
- Exceptional written and verbal communication skills, with the ability to interact professionally with clients and internal/external stakeholders.
- Strong problem-solving and decision-making abilities.
- Ability to handle confidential and sensitive information with integrity and discretion.
- Knowledge of relevant laws, regulations, and compliance requirements in the insurance industry is desirable.

**Salary**: R 15 500 CTC (not negotiable)

**Salary**: R15,000.00 - R15,500.00 per month



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