Claims Capturer: Health at Oneplan Underwriting Managers (Pty) Ltd

Main purpose of the job

• Provides support to clients relating to claims and claim queries. Project a professional company image through customer/provider interaction.

Claims Capturing

• Accurate capturing of claims (80 claims per day minimum)
• Scanning and filing of paper claims
• Inform customers/providers regarding unclear/ incomplete invoices via appropriate methods (email and in writing/ telephonically)
• Answer calls and resolve claim queries within determined SLA
• Transfer customer calls to appropriate staff, where necessary
• Follow-up on customer/provider enquires not immediately resolved, within determined SLA’s
• Immediately follow up with client if the call drops
• Complete call logs and reports
• Follow and adhere to claim processes, procedures and protocol
• Recognize, document and alert the supervisor of trends with processing of claims
• Focus on first call resolution as far as possible
• Explain products and update customer details in computer system.
• Answer WhatsApp chats with customer requests within the determined SLA
• Conduct outbound calls as and when required to ensure client is informed and updated on the progress/ status of the claim
• Improve client service experience, create engaged clients, and facilitate organic growth
• Manages tasks allocated through omni-channel platforms including WhatsApp.
• Handle complex and escalated client service issues
• Build/maintain rapid channel of communication to client in case of service-related issues and events
• Represent the “Voice of the Customer”
• Create a culture of Customer/Client Centricity
• Identify any potential errors or obstacles that may arise which might impact client experience and ensure this has been addressed and highlighted to Supervisor.
• Demonstrate the Oneplan Values and Culture in all engagements with both clients and internal stakeholders.
• Leverage team success to drive all initiatives and experiences with clients.
• Display leadership through your actions by accepting responsibility for daily deliverables and ensuring turnaround times are achieved.
• Maintain forward thinking and proactiveness by taking ownership of every interaction with the client and managing the client’s queries from end-to-end to ensure a world class client service experience.
• Support cross functional work areas targeted to resolve issues raised by clients.
• Proactively gather client feedback to optimize client experience
• Ensure that all Connex queues are selected at all times

Claims Queries

• Provide accurate and efficient To log every call/ query received / made (Connex/ notes OPA)
• Follow-up on customer enquires not immediately resolved, within determined SLA’s.
• Complete call logs and reports.
• Educate clients on claims process
• Ensure that all emails on agent queries are sent back to the claims main queue at the end of business day

Quality, Consistency and Compliance

• Maintain QA standard and ensure error rate does not exceed accepted variance
• Timeous answering of chats within specified SLA (5 minutes)
• In the event that the agent experiences system errors, it should be reported to the Claims Manager immediately
• Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements.
• Ensure adherence to all relevant legislation and regulations as set out by the Company, FSCA, and the Financial Services industry

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
• Should be able to work additional extra hours as and when required

Requirements

Minimum Academic, Professional Qualifications & Experience required for this position

• Grade 12 with English and a second language
• RE5 (preferred)
• 1-2 years working experience in hospital/medical aid or insurance claims processing would be highly advantageous
• Meet FAIS fit and Proper requirements