Claims Processing Consultant at Telesure Investment Holdings (TIH)

• Checking of claims put forward for decision or amendments to original decision as well as all other
• supporting decisions taken throughout the claims process by adherence against the required standard.
• Providing the final sign off and endorsement of decisions put forward on the relevant claims allocated.
• Identify Non-adherence to specific rules & guidelines and make recommendations as part of continuous
• improvement opportunities pertaining to rules, guidelines and processes to your direct line manager.
• Bring disputes pertaining to recommendations made to the attention of the relevant parties by following
• the standard operating procedure to enable resolution.
• Keep record, measure and tracking performance agreed standards to inform decision making in the
• relevant area of responsibility.
• To request additional validation on claims to enable the approval or denying of claims.
• Provides support and assistance to the claims processor function pertaining to pre-determined claims.
• Uphold agreed service level agreements (set turnaround times) and ensuring customer satisfaction and
• retention to the claims function.
• Effectively build, maintain and manage relationships colleagues and internal stakeholders.
• Deliver the Tele sure Service Way through personal effort and through others.
• Deliver on Treating Customers Fairly principles in alignment with regulatory requirements.

Knowledge Of

• Short term insurance knowledge
• Claims processes and procedures knowledge
• Relevant Product knowledge would be an added advantage
• Checking of claims put forward for decision or amendments to original decision as well as all other
• supporting decisions taken throughout the claims process by adherence against the required standard.
• Providing the final sign off and endorsement of decisions put forward on the relevant claims allocated.
• Identify Non-adherence to specific rules & guidelines and make recommendations as part of continuous
• improvement opportunities pertaining to rules, guidelines and processes to your direct line manager.
• Bring disputes pertaining to recommendations made to the attention of the relevant parties by following
• the standard operating procedure to enable resolution.
• Keep record, measure and tracking performance agreed standards to inform decision making in the
• relevant area of responsibility.
• To request additional validation on claims to enable the approval or denying of claims.
• Provides support and assistance to the claims processor function pertaining to pre-determined claims.
• Uphold agreed service level agreements (set turnaround times) and ensuring customer satisfaction and
• retention to the claims function.
• Effectively build, maintain and manage relationships colleagues and internal stakeholders.
• Deliver the Tele sure Service Way through personal effort and through others.
• Deliver on Treating Customers Fairly principles in alignment with regulatory requirements.

Qualification

• Grade 12 / Matric
• 2 years claims admin and validation experience and/or 2 years decision making experience in a claims role
• Relevant FAIS accreditations

Knowledge Of

• Short term insurance knowledge
• Claims processes and procedures knowledge
• Relevant Product knowledge would be an added advantage