|Company||Telesure Investment Holdings|
|Location||Fourways, Gauteng, South Africa|
The Claims Processing Consultant contributes to the organisational goals by reviewing, vetting and endorsing decisions on all claim types handled in the business to support the control of associated claims cost by providing input in terms of possible efficiencies and risk controls associated with claims decision making in the claims operational environments.
|Job Functions||Analytics,Auditing,Compliance & Regulatory Affairs,Data Analysis|
|Industries||Call Centre & Helpdesk,Financial Services,Insurance|
Objectives / Outputs:
•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.
Experience and Requirements
Grade 12 / Matric
2 years claims admin and validation experience and/or 2 years decision making experience in a claims role
Relevant FAIS accreditations
•Short term insurance knowledge
•Claims processes and procedures knowledge
•Relevant Product knowledge would be an added advantage
|Job Closing Date||26/11/2019|