Claims Capturer: Health

6 days ago

Sandton, South Africa Oneplan Underwriting Managers (Pty) Ltd. Full time

**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 Capturing**
- Accurate capturing of claims (80 claims per day minimum)
- Scanning and filing of paper claims
- 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 SLA’s
- Immediately follow up with client if the call drops
- 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 client’s 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 optimize client experience
- Ensure that all Connex queues are selected at all times

**Claims Queries**
- Provide accurate and efficient To log every call/ query received / made (Connex/ notes OPA)
- Follow-up on customer enquires not immediately resolved, within determined SLA’s.
- 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)
- In the event that the agent experiences system errors, it should be reported to the Claims Manager immediately
- Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
- 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

**Self-Management**
- Follow through to ensure that personal quality and productivity standards are consistently and accurately maintained
- Plan and prioritise, demonstrating abilities to manage competing demands
- Demonstrate abilities to anticipate and manage change
- Demonstrate flexibility in balancing achievement of own objectives with abilities to understand and respond to organizational needs
- Should be able to work additional extra hours as and when required

**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

**Functional Competencies**
- Literacy - Have excellent reading, writing and interpersonal skills
- 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

**Essential**
- Investigate Issues
- Problem Solving
- Building Relationships
- Communicating Information
- Showing Resilience
- Adjusting to Change
- Giving Support
- Processing Details
- Structuring Tasks
- Driving Success
- Prio

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