Claims Processing Consultant (Nedbank)

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 customers requirements, explain the product/service features influence the customer to add additional

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)

TASKS

Prepare insurance claim forms or related documents and review them for completeness.

Enter claims information into database systems.

Pay small claims.

Calculate amount of claim. Post or attach information to claim file.

Contact insured or other involved persons to obtain missing information.

Review insurance policy to determine coverage.

Organize or work with detailed office records, using computers to enter, access, search or retrieve data.

Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.

Finalise claims and send to services department.

Listen and transcribe client conversations Request Client Conversation

Retrieve Client Conversation

Issue repair / replace vouchers

Load and action 15 minute messages

Complete TTDs and requests

ADDITIONAL INFORMATION

SAQA Accredited Equivalent - It is the onus of the applicant to provide TIH and its subsidiaries with certified evidence that their qualification(s) meet the equivalent NQF level required for this role at time of application. As a registered Financial Service Provider, we are mandated to ensure that all our representatives are and remain fit and proper at all times. By applying for this role, you consent to having your relevant qualification and or accreditation orconfirm that you are working towards meeting the competency requirements. You further consent to the relevant information being verified