Claims Quality Assurance Technician at Telesure Investment Holdings (TIH)

Responsibilities

Claim Quality Audit and Decisions

• Conduct complex analyses, quality tests and inspections for already processed claims as well as mandated claims.

Insurance Claims Administration

• Process assigned straightforward insurance claims, ensuring that each claim is supported by valid documentation and supporting evidence, and meeting defined customer service standards. Authorise claims within delegated authority and refer complex or unresolved issues to senior colleagues.

Data Collection, Analysis & Reporting

• 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 claims. Contribute to the preparation of various claims reports for Senior Management.

Work Scheduling and operational compliance

• Organise 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 stakeholders on the claims administration process and other departmental systems, in line with claims policy, rules and SLAs.

Document Management

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

Education

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

Experience

• 1-3 years' claims experience within the Non-Life Financial Services industry (Essential).