Claims Processing Consultant at Telesure Investment Holdings (TIH)

JOB 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) Help manage customer by carrying out standard activities to complete the customer request. Data Collection & Analysis Ask questions, collect data from a variety of sources, analyse information and investigate claim. Make decisions according to established criteria to ensure standardisation across the organisation by accurately administrating and underwriting claims. Use appropriate tools (ITC, supplier contract and/or negotiation) to accurately cost applicable claims on a day to day basis.

Work Scheduling and operational compliance

• Organize 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 current and new product knowledge to enable effective decision making.

Administration

• 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

• Respond to routine requests using telephonic conversation or emails (internal and external). Ensure regular feedback to services department and other stakeholders, as determined by the company and/or customer requirements to ensure customer receives appropriate feedback from the services department.

Document Management

• Create, organize and maintain files containing the correspondence relating to policies and matters.

Document Preparation

• Prepare and manage claim documentation for customers. Up-sell Customer Propositions Identify a selection of products or services that may meet the customer's requirements, explain the product/service features influence the customer to add additional

TECHNICAL COMPETENCIES

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 Organizing

• Works without supervision and provides technical guidance when required on planning, organizing, prioritizing and overseeing 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 organizational strategies and objectives.

Knowledge of general VAPS claims 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 analyze data to critically evaluate information to ensure accuracy of content.

Internet browser knowledge

• Applies concepts of knowledge / skill without requiring supervision; also able to provide technical guidance when required

Requirements

EDUCATION

General Education

• Matric / Grade 12/ SAQA Accredited Equivalent (Essential); Regulatory exam 5 (Advantageous)

EXPERIENCE

General Experience

• 1-3 years Financial Services industry experience (Essential) STI experience and VAPS experience (Advantageous)