Claims Validator/Assessor (JHB Hybrid) at Datafin Recruitment

ENVIRONMENT:

• A provider of tailored Financial Solutions seeks a highly meticulous Claims Validator/Assessor to ensure a seamless process for clients. You will be responsible for the preparation, validation, and finalisation of all registered claims – ensuring efficient and effective settlement of registered claims within the terms of the relevant Policy wording, agreed quality standards and business rules.
• You will also actively manage the validation of claims which need to be paid, repudiated, or forwarded to the awaiting info queue. Applicants must have Matric/Grade 12 with 3-5 years Claims Assessment / Validator experience and must be able to communicate in English, Afrikaans and Zulu/Setswana.

DUTIES:

• Handle claim queries received from Claims Assessors, Supervisor, or Manager.
• Assist clients with claims queries or concerns.
• Liaise with the Claims Assessor and advise them of any issues that arise.
• Meet the required production levels and quality standards, assigned to them by their Supervisor, and their Manager.
• Handle the validation of captured and registered claims.
• Pay attention to detail when validating claims.
• Prepare the reconciliation of validated claims which need to be paid at the end of the day.
• Manage and prepare the daily claims metrics reports.
• Adhere to processes, scripts, and standard operating procedures (Q.A).
• Validate claims on Dionysus.
• Assist with training and upskilling the team across assessments, declined claims, and fraud identification and investigation.
• Ensure great customer service for the client.
• Liaise with their team members and interdepartmental team members on Claim queries on behalf of the member.
• Actively manage all aspects of the claim’s validation process.

REQUIREMENTS:

• Matric/Grade 12.
• 3 – 5 Years of Claims Assessment / Validator experience is required.
• Microsoft Office.
• Must understand the importance of providing the customer/ member with good service and settling claims on time.
• Good communication skills.
• Punctual, dedicated, hardworking, quick learner and honest.
• Able to communicate in English, Afrikaans, Zulu or Setswana and an added bonus if they can speak Xhosa, Tsonga or Venda.
• Good listener.
• Team player.
• Someone not afraid to work extra hours/overtime if need be.