Claims Specialist

Introduction Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members

Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page
Role Purpose The successful incumbent will deliver effective and efficient service to clients by receiving, evaluating, and responding to enquiries timeously

Requirements Qualification

• Matric.
• Tertiary qualification (advantageous).
• Claims School training (advantageous).

Experience

• Claims assessing experience (essential).
• 1-3 years of experience in the medical aid industry (essential).
• 2-3 years of Claims processing experience within the medical aid industry (essential).
• 2-3 years of query management or client service experience (essential).

Knowledge

• Knowledge of PMB process (advantageous).
• Good understanding of the MH systems (advantageous).
• Proficiency in Microsoft Office applications, including email, Word, and Excel (essential).
• Understanding and knowledge of the interpretation and application of CMS, Department of Health, BHF, Private hospitals, etc., (advantageous).
• Good written and verbal communication.

Duties & Responsibilities

• Identifying risks to the company and escalating accordingly.
• Engage in effective communication and delivery according to service levels.
• Maintaining a consistent service delivery to ensure client retention and satisfaction.
• Respond to queries efficiently within the agreed Service Level Agreement (SLA).
• Providing first-time resolution on queries.
• Driving and supporting effective teamwork within the department.
• Engaging in appropriate training interventions to promote own professional development.
• Demonstrate the company's values on a daily basis.
• Recording of all queries and interactions with customers onto all applicable systems.
• Escalate client queries to the relevant department or stakeholder via the applicable channel.
• Collaborate with relevant departments to ensure the resolution of queries.
• Develop and maintain productive and collaborative work relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.

Competencies

• Continuously develop own expertise in terms of professional, industry, scheme and legislation knowledge.
• Identify opportunities to enhance cost-effectiveness and increase operational efficiency.
• Business Acumen.
• Client/Stakeholder Commitment.
• Drive for Results.
• Leads Change and Innovation.
• Collaboration.
• Impact and Influence.
• Works independently.
• Diversity and Inclusiveness.