Risk Claims Administrator

Overview

Claims Quality Assurance

• Perform end-to-end QA checks in line with the Fund’s Quality Assurance checklist.
• Verify completeness and accuracy of claim forms and supporting documentation.
• Ensure all claim documentation is correctly completed, signed and compliant with Fund requirements.
• Confirm alignment between claim data and system records (Everest system).
• Identify and escalate discrepancies or missing information to relevant stakeholders.
• Ensure all mandatory supporting documents are received and compliant.
• Conduct due diligence checks including verification of member details (ID, name, DOB, tax number, banking details and employer information).
• Identify outstanding loans or indebtedness in line with applicable legislation (Section 37D / Section 19(5)(a)).
• Perform member and beneficiary bank account verification after workflow loading.
• Check for possible matches on the Unclaimed Benefit Fund register.

Record Keeping and Filing

• Maintain accurate and complete records on the Everest system.
• Ensure all correspondence is properly attached to member/deceased member files.
• Capture accurate case notes and updates on the system.

Query resolution

• Respond to internal and external email and telephonic queries efficiently and professionally.
• Liaise with Client Services, Contact Centre, Compliance, employers, and service providers to resolve queries.
• Provide continuous feedback until queries are fully resolved.
• Attend to escalations within 24–48 hours.
• Support Contact Centre and Claims Administrators with information and documentation requests.

Performance & Productivity

• Meet daily production target of 30 cases per day.
• Maintain an error rate of less than 1%.
• Ensure high levels of accuracy, efficiency and compliance under pressure

Team Support

• Contribute positively within the team environment and support colleagues where required.
• Take accountability for allocated work and deliver within agreed timelines.
• Participate in projects and additional business initiatives as required.
• Work overtime when operationally required

Relationship Management

• Build and maintain strong working relationships across internal departments and external stakeholders.
• Promote a professional, responsive, and client-centric service culture.
• Uphold the company’s reputation, values, and service standards at all times

Time Management

• Excellent time management
• Must be available to work overtime when the need arises.
• Flexible and ability to work under pressure and multitask.
• Accuracy and attention to detail
• Strong decision-making and analytical thinking
• Effective communication and interpersonal skills
• Time management and organisational ability
• Conflict management and negotiation skills
• Ability to work independently and in a team
• Commitment to compliance and ethical standards

Required Qualifications & Experience

• Matric (Grade 12)
• Proficiency in Microsoft Excel
• Knowledge of FICA, POPIA & Treating Customers Fairly (TCF) principles
• Strong written and verbal communication skills
• Experience in employee benefits / claims administration (advantageous)
• Strong attention to detail and analytical ability
• Ability to work under pressure and meet strict deadlines
• Strong stakeholder engagement and customer service skills