Business Claims Specialist
1 week ago
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 12
- 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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