Claims Administrator at Oneplan Underwriting Managers (Pty) Ltd

Job Description

Main purpose of the Job

• Provide exceptional Claims administration for the company’s Short-Term Policy holders. To liaise with internal and external parties daily. Responsible for the processing of claims made under the shared policies, including the reporting of claims to the insurance carriers, management and defense of claims and providing for appropriate release upon settlement of claims.

Customer Service

• Coordinate insurance process across departments, tracking claims and reporting on aggregate metrics.
• Manage the claims intake process for new claims, including gathering information from customers.
• Determining whether claims are eligible for coverage under the terms of each insurance policy.
• Reviewing records to determine if they support a claim.
• Communicating with customers about their claim status, payment amounts, and any other pertinent information.
• Daily administration and feedback on claims.
• Capture claim details of client and check if premiums have been collected and are up to date.
• Check system and determine that clients cover is active before allowing a claim.
• Explain claims process and required documentation to clients.
• To manage the claim cycle time.
• Contact clients and service providers during the claim cycle time.
• Identify potential fraudulent claims
• To cancel Cover and provide feedback to the SAICB if fraud or misrepresentation was discovered.
• To send upliftment request on salvage vehicles
• To draft loss agreements and rejection or repudiation letters.
• Provide exceptional claim service to clients.
• Review claim submissions and determine eligibility and level of coverage.
• Prepare and monitor insurance budgets and report on exceptional circumstances.
• File claims, enter data, and update databases with current daily information.
• Other duties as assigned from time to time

Turn-Around Time

• Deliver quality service by providing efficient, quick, and friendly service to clients within agreed SLA.
• Respond to clients' issues timeously and swiftly, within escalation parameters to ensure consistency.
• Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
• Submit all relevant reports as directed, in a timeous manner to the manager
• Keep all claims within the required turnaround times.
• Ability to work according to strict deadlines and be organised and efficient

Process Adherence 

• Ability to manage their own workload.
• Always comply with company policy and procedures 
• Pro-active approach to process improvement.
• Any additional responsibilities as required from time to time

Work Collaboratively 

• Build a culture of respect and understanding across the organisation
• Recognise outcomes which resulted from effective collaboration between teams
• Build cooperation and overcome barriers to information sharing, communication and collaboration across the organization
• Facilitate opportunities to engage and collaborate with internal and external stakeholders to develop joint solutions

Self-Management

• Follow through to ensure that personal quality and productivity standards are consistently and accurately maintained
• Demonstrate consistent application of internal procedures
• Plan and prioritise, demonstrating abilities to manage competing demands
• Demonstrate abilities to anticipate and manage change
• Demonstrate flexibility in balancing achievement of own objectives with abilities to understand and respond to organizational needs

Job Requirements

Minimum Academic, Professional Qualifications & Experience required for this position

• Grade 12
• Minimum 1 - 2 years experience in a similar role
• RE5 (Advantageous)

Behaviors

• Energy       
• Passion     
• Respect for others
• Honest and Fair
• Positive Attitude
• Client Focus
• Tenacity     
• Achieves Results    

Essential

• Evaluating Problems
• Investigate Issues
• Problem Solving
• Building Relationships
• Communicating Information
• Showing Resilience
• Adjusting to Change
• Giving Support
• Processing Details
• Structuring Tasks
• Prioritise Client Experience

Functional Competencies

• PC Literacy- word, excel, email and internet
• Ability to communicate effectively and clearly in writing and verbally, including drafting correspondence and documents
• Attention to detail and accuracy
• Ability to work independently
• Function under pressure and ability to work under strict deadlines
• Adaptability
• The ability to resolve problems and disputes with clients
• Client Relationship Management