Claims Administrator - Funeral

SUMMARY:
Our claims department is looking for experienced individuals with Funeral claims experience to process health and funeral claims as required. Keep claimants informed of the claim’s progress and requirements

POSITION INFO:

• Key Tasks

  Process, and Capture, Claims Information

  • Respond to members/claimants and request all required documents.
  • Validate policy status, nominated dependants and beneficiaries
  • Confirm policy terms and conditions are met. (e.g. waiting periods, general exclusions)
  • Check that all claim documentation is accurate, complete and compliant with protocols, processes and relevant legislation
  • Clarify details regarding claims (both verbal and written)
  • Capture relevant claim information (e.g., approved documents and claim related notes) on the appropriate platform (e.g., funeral claim register)
  • Process claims accurately

  Engage With Members/Claimants and Service Providers Regarding Queries

  • Check that all applicable documents are received and captured
  • Liaise with the relevant affiliations to resolve issues around incorrect or incomplete documentation
  • Obtain additional or missing information
  • Provide accurate information to clients to provide excellent service
  • Conduct security checks before information is disclosed to clients
  • Follow-up and provide ongoing feedback to claimants and service providers until finalised
  • Escalate completed claim to the Claim Assessor for final processing
  • Escalate any red flags/discrepancies, if identified, to the Claims Assessor.

  Perform General Administrative Tasks

  • Uphold tight SLA adherence throughout the entire claims processing activity.
  • Maintain strict adherence to all verbal or written instructions
  • Maintain strict compliance with company policies and regulatory requirements
  • Keep abreast of amendments to policy rules, benefit options, legislation, protocols, processes and systems
  • Undertake any other duties as determined by the business needs
  Essential Qualifications
  • • Matric
  Essential Experienc
• • • Minimum 2 years in the insurance industry
    • Experience in customer care and service delivery

  Knowledge and Skills

  • • Computer Literate
    • Strong inter-personal skills
    • High standard of verbal and written communication skills