Claims Administrator at Discovery Limited

Key Purpose

• The primary function of this role is to support the identification, assesses and management claims with internal and external stakeholders within the Disability Management process from Early Identification through the lifecycle of the claim. The individual will be responsible for the technical pre-assessment of claims, queries, and relationship management. You will therefore need advanced technical skills, particularly in excel, excellent communication skills, and be comfortable working to extremely tight deadlines. The goal of the role is to manage the disability claims experience through innovative and efficient claim administration principles.

Areas of responsibility may include but not limited to

• Technical assessment of claim by checking the applicable cover, scheme and member details, eligibility, financial details etc. on compass, Discovery Health and on ASISA (Association for Savings and Investment South Africa)
• Assess and confirm the eligibility, authenticity and validity of all evidence submitted by clients
• Move the claims from pre-assessment pool to assessment on Claims Management System
• Acknowledge all information received and let the client know who the assessor is.
• Request additional information and explain why the information is still required If there is no medical information shared in any evidence or forms submitted
• Assess and confirm the eligibility, authenticity, and validity of Certificates of Existence Claims
• Assess and confirm the eligibility, authenticity, and validity of all notifications
• Capture all types of claims, incoming and outgoing information, and notifications on the Claims Allocation sheets/platform
• Maintains, arrange, organize, and update the filing systems and procedures on SharePoint
• Sending out reminder letters on due dates for all pending claims and existing claims that are undergoing reviews.
• Keeping records and processing payments of medical accounts
• Responding to queries, especially account queries, immediately
• Proving claim experience, list, or monthly report to the customers, including pricing and Customer Service advisor.
• Following up on reports and confirming appointments date payments
• Ensuring that all documentation and communication sent out meets all technical and professional compliance
• Ensuring that all queries are dealt with professionally, effectively, and stipulated turn-around times are met
• Ensuring effective communication with role players involved
• Attending client meetings to support team as needed
• Data management on data management system including monthly claims register submission
• Validating data on claims registers

Personal Attributes

• Resilient
• Adaptable/ flexible
• Dependable and Reliable   
• Elevated level of Integrity
• Tenacity
• Self-starter with a high attention to detail and be able to multi-task
• Good at follow through
• Exceptional ability to communicate written and orally
• Problem solving and solution focused
• Analytical – interpretation
• Building relationships
• Coping with pressure
• Time-Management and Organizational Skills
• Must be team orientated, willing to assist other team members in the office
• Compassion: will be working with people who are sometimes in dire situations or going through difficult transitions. Must be compassionate to their situation and working with them in a positive way
• Outstanding customer service skills

Education and Experience

• Matric-essential
• Tertiary qualification is administration, data management advantageous
• Telephone etiquette, detail orientated and self-driven. Customer centric focus to be evident.
• MS Office- Advanced Excel skills, operational processes, and process mapping.
• 2 – 4 years claims experience in the long-term insurance industry. Pension and Provident Fund experience is advantageous