SUMMARY:
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POSITION INFO:
ENVIRONMENT:
AN established player in the South African long-term insurance market seeks a Claims Validator to provide exceptional claims experience & ensure that the claim settlement processes are seamless and trouble-free for clients. You will be responsible for the preparation, validation, and finalisation of all registered claims. The Claims Validator must actively manage the validation of claims which need to be paid, repudiated, or forwarded to the awaiting info queue while ensuring efficient and effective settlement of registered claims within the terms of the relevant Policy wording, agreed quality standards and business rules. Applicants will need Matric/Grade 12 and 3-5 years of Claims Assessment / Validator experience and must understand the importance of providing the customer/member with good service and settling claims on time.
DUTIES:
- Handle claim queries received from Claims Assessors, Supervisor, or Manager.
- Assist clients with claims queries or concerns.
- Liaise with the Claims Assessor and advise them of any issues that arise.
- Meet the required production levels and quality standards, assigned to them by their Supervisor, and their Manager.
- Handle the validation of captured and registered claims.
- Pay attention to detail when validating claims.
- Prepare the reconciliation of validated claims which need to be paid at the end of the day.
- Manage and prepare the daily claims metrics reports.
- Adhere to processes, scripts, and standard operating procedures (Q.A).
- Validate claims on Dionysus.
- Assist with training and upskilling the team across assessments, declined claims, and fraud identification and investigation.
- Ensure great customer service for the client.
- Liaise with their team members and interdepartmental team members on Claim queries on behalf of the member.
- Actively manage all aspects of the claim’s validation process.
REQUIREMENTS:
- Matric / Grade 12.
- Computer literate.
- 3 - 5 years of Claims Assessment / Validator experience is required.
- Microsoft Office.
- Punctual, dedicated, hardworking, quick learner and honest.
- Must understand the importance of providing the customer/ member with good service and settling claims on time.
- Good communication skills.
- Able to communicate in English, Afrikaans, Zulu or Setswana and an added bonus if they can speak Xhosa, Tsonga or Venda.
- Good listener.
- Team player.
- Someone not afraid to work extra hours/overtime if need be.
- Compassionate.
