Job Description

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 Administrator

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 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 optimise client experience

Claims queries

Provide accurate and efficient To log every call/ query received/made (Connex/ notes OPA) Follow-up on customer enquiries not immediately resolved, within determined SLA's. Complete call logs and reports. Educate clients on claims process

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) Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge in client engagements. All Email/WhatsApp interactions must be returned to the queue at the end of every shift. A Screenshot of your Connex interaction page needs to be sent to your line manager at the end of your shift. (Two screenshots, one with the interactions in your queue {If applicable} and one after you have transferred the interactions to the queue.) Clear Download History and Cache daily. Ensure that your recycle bin is empty. 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.

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 In-depth knowledge of Health/ Pet Insurance

Behaviors

Punctual Energy Passion Respect for others Honest and Fair Positive Attitude Client Focus Tenacity Achieves Results Team player

Essential

Investigate Issues Problem Solving Building Relationships Communicating Information Showing Resilience Adjusting to Change Giving Support Processing Details Structuring Tasks Driving Success Prioritise Client Experience

Functional Competencies

Literacy - Have excellent reading, writing and interpersonal skills Pc Literacy - In-depth knowledge of Word, excel, email and Internet Ability to respond according to TAT Client relationship management Maximise service performance Query resolution Build & develop client centric capabilities Deliver on client expectations Knowledge Sharing Driving excellence through client experience Driving excellence through client experience

Leadership

Demonstrate honesty and integrity Strive for Client Centricity Be agile and have the ability to adapt to change Build relationships and trust Be an agent of change Collaborative * Share your views