Role Purpose:
Process already-captured claims efficiently and accurately through drawing on the relevant criteria to ensure standardisation across the organisation to enable decision making on a claim.
Responsibilities:
Customer Management (Internal) | Clients - Customer Management
Help manage customers by carrying out standard activities to complete the customer request.
Data Collection & Analysis | Data and Analytics
Ask questions, collect data from a variety of sources, analyse information and investigate claims. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools to accurately cost applicable claims on a day-to-day basis.
Work Scheduling and operational compliance | People - Leadership and Supervision
Organise your own work schedule in order to get the job done, coordinating with support services and completed work within SLA. Ensure claims are finalised within the set parameters (turnaround time, terms and conditions applied accurately). Remain up to date with current and new product knowledge to enable effective decision making.
Administration | People - Leadership and Supervision
Produce, update, and provide best practice support to customers on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.
Correspondence | People - Leadership and Supervision
Respond to routine requests using telephonic conversation or emails (internal and external).
Document Management | Data Management
Create, organise and maintain files containing the correspondence relating to policies and matters.
Document Preparation | Data Management
Prepare and manage claim documentation for customers.
Behavioral Competencies:
Customer Focus - Builds strong customer relationships and delivers customer[1]centric solutions. For example, probes deeply into customer needs to identify less obvious interests or expectations. Consistently goes above and beyond to understand customer requirements and surpass their expectations.
Decision Quality - Makes good and timely decisions that keep the organization moving forward. For example, knows when to act independently and when to escalate issues. Integrates various inputs, decision criteria, and trade-offs to make effective decisions. Typically makes good independent decisions.
Manages Complexity - Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems. For example, it looks at complex issues from multiple angles; explores issues to uncover underlying issues and root causes; sees the main consequences and implications of different options.
Drives Results - Consistently achieves results, even under tough circumstances. For example, devotes considerable effort to surpassing goals and achieving the best possible results; goes above and beyond to achieve excellence. Drives ahead with great focus when faced with obstacles and setbacks; maintains productivity and a positive attitude.
Being Resilient - Rebounds from setbacks and adversity when facing difficult situations. For example, is calm and professional in difficult situations; continues to work toward objectives. Overcomes obstacles without becoming discouraged; draws lessons from failures. Recovers from setbacks and adversity.
Manages Conflict - Handles conflict situations effectively, with a minimum of noise. For example, disagrees with others in a respectful and tactful manner; handles conflicts and differences of opinion in a calm, composed manner; rebounds from conflicts without animosity.
Communicates Effectively - Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences. For example, listen attentively and take an interest. Keeps others well informed; conveys information clearly, concisely, and professionally when speaking or writing.
Ensures Accountability - Holds self and others accountable to meet commitments. For example, accepting responsibility for your own work, both successes and failures. Handles fair share and does not make excuses for problems. Usually meets commitments to others.
Plans and Aligns - Plans and prioritizes work to meet commitments aligned with organizational goals. For example, outlines clear plans that put actions in a logical sequence; conveys some time frames. Aligns own work with relevant workgroups. Take some steps to reduce bottlenecks and speed up the work.
Collaborates - Builds partnerships and works collaboratively with others to meet shared objectives. For example, learns how to operate as a team player, contributing actively to the group''s efforts. Seeks others'' inputs, appreciates their contributions; offers to help when the need is clear.
Skills:
Verbal Communication - Uses clear and effective verbal communications skills without supervision and provides technical guidance when required on expressing ideas, requesting actions, and formulating plans or policies.
Numerical Skills - Uses an understanding of numerical concepts to perform mathematical operations such as report analysis with guidance (but not constant supervision).
Computer Skills - Supports business processes without supervision by understanding and effectively using standard office equipment and standard software packages, while providing technical guidance as needed. Basic Computer Skills, Microsoft Office Basic
Planning and Organising - Works with guidance (but not constant supervision) to plan, organise, prioritise and oversee activities to efficiently meet business objectives.
Policy and procedures - Works with guidance (but not constant supervision) to develop, monitor, interpret and understand policies and procedures, while making sure they match organisational strategies and objectives. Knowledge Of General STI Industry Policy and Procedures
Action Planning - Works with guidance (but not constant supervision) to develop appropriate plans or perform necessary actions based on recommendations and requirements.
Data Collection and analysis - Works under guidance to analyse data to critically evaluate information to ensure accuracy of content.
Internet Browser Knowledge - Works with full competence to use a range of Internet browsers to access data. Typically works without supervision and may provide technical guidance.
Education:
General Education:
Matric / Grade 12/ SAQA Accredited Equivalent (Essential)
Experience:
General Experience:
1 or more years Financial Services industry experience (Essential);
Call Centre Experience (Essential);
STI experience (Advantageous);
1 or more years Claims Experience (Advantageous);
At least 2-3 years’ experience in a Customer Service environment (Advantageous)
