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Claims Process Specialist

1 month ago

Benoni, Gauteng, South Africa National Risk Managers Full time

National Risk Managers is seeking an experienced Claims Process Specialist to join their team.

As a Claims Process Specialist, you will be responsible for processing and managing claims efficiently, ensuring that all necessary documentation is accurate and complete. This includes validating policy status, nominated dependants, and beneficiaries, as well as confirming policy terms and conditions are met.

Your primary duties will include:

  • Responding to members/claimants and requesting all required documents;
  • Validating policy status, nominated dependants, and beneficiaries;
  • Confirming policy terms and conditions are met;
  • Checking that all claim documentation is accurate, complete, and compliant with protocols, processes, and relevant legislation;
  • Capturing relevant claim information on the appropriate platform;
  • Engaging with members/claimants and service providers regarding queries;
  • Liaising with affiliations to resolve issues around incorrect or incomplete documentation;
  • Obtaining additional or missing information;
  • Providing accurate information to clients to provide excellent service;
  • Following-up and providing ongoing feedback until finalised;
  • Escalating completed claims to the Claim Assessor for final processing;
  • Escalating any red flags/discrepancies to the Claims Assessor;

In addition to your technical skills, you should possess strong inter-personal skills, a high standard of verbal and written communication skills, and be able to work effectively under pressure.

The ideal candidate will have a minimum of 2 years in the insurance industry, experience in customer care and service delivery, funeral claims processing experience, and health claims experience.

We offer a competitive salary range of $60,000 - $80,000 per annum, depending on experience.