Claims Specialist

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property 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.

As an applicant, please verify the legitimacy of this job advert on our company career page.

The successful incumbent will be responsible for providing an effective and efficient service to clients by receiving, evaluating, and responding to enquiries timeously.

• Matric


• Tertiary qualification (advantageous)


• Claims school training (advantageous)

Experience

• Experience in claims assessing (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

• Understaning of PMB process (advantageous).


• Good understanding of the MH systems (advantageous).


• Understanding and knowledge of the interpretation and application of CMS, Department of Health, BHF, Private hospitals, etc., (advantageous).


• Computer Literacy (essential).


• Good written and verbal communication

• 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.

Client

• Offer authoritative expertise to clients and stakeholders regarding claims matters.


• Foster and maintain strong relationships with clients and internal and external stakeholders.


• Fulfill service level agreements with clients and stakeholders to effectively manage client expectations.


• Make recommendations for enhancing client service and ensuring fair treatment within the scope of responsibility.


• Actively participate in creating a culture that values relationships, encourages feedback, and delivers exceptional client service.

People

• Develop and maintain productive and collaborative relationships with peers and stakeholders.


• Actively contribute to and support change initiatives within the organization.


• Continuously enhance professional expertise in terms of industry knowledge, legislation, and best practices.


• Contribute to continuous innovation by sharing and implementing new ideas.


• Take ownership of career development and drive personal growth.

Finance

• Identify opportunities to improve cost-effectiveness and operational efficiency.


• Manage financial and other resources under your control with diligence and responsibility.


• Provide input into risk identification processes and communicate recommendations in the appropriate forums.