Claims Administrator – Group Risk

KEY OUTPUTS

• Ensure accurate and timeous acknowledgement & settlement of risk claims (in accordance with processes, procedures, reinsurance treaties, administration agreements, regulatory requirements, and service level agreements).
• Assessment and processing of Death, funeral, and Educator benefit claim
• Ensure that payment process is in line with legislation (Approved benefit / Unapproved benefit - nomination of beneficiary form or estate late payment)
• Ensure all claims communication is clear, acknowledgement done within 24hrs and that clients/claimants are kept up to date during the claims process
• Ensures that standards are maintained in accordance with processes, procedures, reinsurance treaties, administration agreements, regulatory requirements, and service level agreements.
• Preparing and issuing of standard monthly client claim reports within SLA for clients, brokers, or Third-Party Administration meetings
• Preparing claims data or report to admin team on request (for termination process)
• Deals with clients / brokers / Sales Consultants and internal specialist departments through correspondence, telephone, e-mail.
• Ensures that workflow system & daily production stats are maintained and always updated.
• Participates in various meetings and contributes to the discussions and decisions of the team and department from a servicing strategy perspective.
• Maintain good relationships with all stakeholders
• Resolve queries and complaints within SLA
• As need, follow the Ex-gratia claims process by preparing requests with information and evidence for committee
• To be involved with system testing
• Assist with project work, processes, and functions for operational team (when required), Storm UAT testing, POPI, FICA, etc.
• Annually successfully completes Regulatory HGR compulsory training on Learnovate (FICA: Anti Money Laundering Awareness Training and Financial Crime Risk Management (FCRM)
• As and when attends PRODUCT TRAINING and completes courses on E-LEARNING
• Assists management to control the costs of running the department by not abusing the use of company assets such as stationery and telephones, and by finding alternative methods which increase efficiencies or reduce costs.

QUALIFICATIONS

• Minimum of Grade 12 (Matric)
• Strong understanding of the financial services industry and a minimum of 2years insurance experience
• Minimum of 2 years administration experience in a claims and policy administration environment

SKILLS

• Analytical
• Very good organisational skills
• PC Skills (Word, Excel, Outlook)
• Excellent interpersonal skills
• Excellent communication (written and verbal)
• Customer Service Skills

PERSONAL ATRIBUTES

• Integrity
• Patience and tolerance
• Able to work under pressure
• Reliable
• Achievement driven
• Results and Action orientated
• Ability to deal with stressful environment and situations
• Ability to work with and present to various stakeholders
• Attention to detail