Claims Specialist

7 days ago

Cape Town, South Africa Momentum Metropolitan Holdings Full time

-Introduction
Role Purpose

To provide an effective and efficient service to clients by receiving, evaluating, and responding to inquiries timeously.
Requirements
- Matric
- Relevant tertiary qualification would be an advantage, CustomerRelationship Management, Business Management, ProjectManagement, Operations Management.
- Claims School training
- Computer Literacy (i.e. E-mail, Word and Excel).
- Experience in claims assessing.
- 4 - 6 years in the medical aid industry
- 2 - 3 years Claims processing experience within the medical aidindustry or
- 2 - 3 years of query management experience or
- 2 - 3 years of client service experience
- Extensive claims processing experience
- Knowledge of GEMS Scheme rules and tariffs
- Good understanding of the MH systems would be an advantage
- Good written and verbal communication
Duties & Responsibilities
- **Relationship Management;**:

- Identifying risks to the company and escalating accordingly
- Engage in effective communication and delivery according to service levels
- Maintaining a consistent service delivery to ensure client retention and satisfaction
- Obtaining and maintaining broad product and industry knowledge in order to effectively and accurately respond to customer queries
- Ensuring Service Level Agreements are met and exceeded at all times
- Providing first-time resolution on queries
- Dealing promptly with client requests in a competent, efficient, and professional manner
- Driving and supporting effective teamwork within the department
- Engaging in appropriate training interventions to promote own professional development
- Demonstrate the company's values on a daily basis
- Recording of all queries and interactions with customers onto all applicable systems
- To ensure the required turnaround time is met
- To ensure that all correspondence sent out is of the highest quality
- **Client Services;**:

- Investigate client queries within the agreed service level and ensure that client receives timeous and accurate feedback
- Escalate client queries to the relevant department or stakeholder via the applicable channel
- Collaborate with relevant departments in ensuring the resolution of queries
- Participate and contribute to a culture that builds rewarding relationships, facilitates feedback, and provides exceptional client service
- **People;**
Develop and maintain productive and collaborative work relationships with peers and stakeholders
- Positively influence and participate in change initiatives
- Continuously develop own expertise in terms of professional, industry, Scheme, and legislation knowledge
- Contribute to continuous innovation through the development, sharing, and implementation of new ideas
- Identify opportunities to enhance cost-effectiveness and increase operational efficiency.
Competencies
- Business Acumen
- Client/ Stakeholder Commitment
- Drive for Results
- Leads Change and Innovation
- Collaboration
- Impact and Influence
- Works independently
- Diversity and Inclusiveness

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

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