Work-Force
Overview: The Claims Specialist is responsible for managing the assessment and processing of insurance claims. The role demands specialized knowledge of the claims environment and focuses on resolving claims accurately and efficiently while maintaining exceptional customer service.
Key Outcomes:
- Claims Processing:
- Process claims with accuracy and efficiency.
- Ensure all claims and related queries are addressed within the agreed turnaround times.
- Customer Service:
- Assist clients with their queries and provide suitable resolutions.
- Handle multiple telephonic queries from members, brokers, and franchises.
- Provide ongoing feedback to clients.
- Administrative Tasks:
- Complete administrative targets accurately on a daily basis.
- Ad Hoc Duties:
- Support operations in other divisions as needed.
- Perform additional functions as required by management.
- Continuous Improvement:
- Contribute to the enhancement of processes and procedures.
- Drive innovation at the process and procedure level.
- Risk Management:
- Contribute to risk management efforts by ensuring compliance with relevant procedures and policies.
Qualifications:
- Required:
- Experience: Insurance industry experience.
- Education: Matric.
- Certifications: FAIS / RE5.
- Preferred:
- Experience: Health insurance industry experience.
- Certifications: FAIS / RE5 Accreditation with a minimum of 120 credits.
Technical Skills and Knowledge:
- Required:
- Computer Literacy: Proficiency in Microsoft Access and other relevant software.
Personal Attributes:
- Accountability: Take ownership of responsibilities and outcomes.
- Action-Oriented: Proactive in addressing tasks and resolving issues.
- Collaborative: Work effectively with others and support team efforts.
- Communication: Strong verbal and business writing skills.
- Problem-Solving: Ability to address and resolve complex issues effectively.
- Decision-Making: Make informed and effective decisions.
- Engagement: Encourage active participation and engagement from others.
- Resilience and Adaptability: Ability to adapt to changing situations and remain resilient under pressure.
- Resourcefulness: Utilize available resources effectively to solve problems.
- Self-Awareness: Demonstrate self-awareness and a commitment to personal and professional growth.
- Purpose-Driven: Align with organizational goals and values.
- Values-Oriented: Demonstrate a strong commitment to company values and ethical standards.
This role is crucial for maintaining the integrity and efficiency of the claims process while ensuring high levels of client satisfaction. If you meet the qualifications and embody the attributes outlined, we encourage you to apply for this role.