Purpose

The successful candidate will be responsible for ensuring that all claims are handled efficiently

and that payment for valid claims are made to the claimant timeously. Involved in managing a

claim from beginning through to settlement.

Key requirements of the role – Knowledge and experience

Education and specialist skills

• Matric
• RE 5 preferably
• Post graduate diploma/degree in finance/administration

• Other insurance related qualifications

Responsibilities and KRA’s

The incumbent is expected to

• Assess validity of all claims (Mdende, EPI, Group scheme, Smart Life funeral and all

• other claims within EasyPay Insurance).

• Evaluate claims and determine requirements
• Manage own claims including complex claims
• Proactively adhere and contribute to the overall achievement of turn-around times and SLAs

• Undertakes individual claims for final reviews
• Make claim decisions according to your authority level
• Process new insurance claims notifications
• Collect accurate information and documents to proceed with a claim
• Analyse claims submitted;
• Show initiative to build and maintain knowledge of claims industry
• Monitor the progress of a claim
• Keep accurate records of all claims assessed in accordance with departmental procedures.
• Fraud detection by identifying and reporting potential fraud
• Ensure fair settlement of a valid claim
• Assist claimants on how to proceed with the claim
• Build relationships with internal and external clients
• Ensure customers are treated fairly and that the customers receive excellent service in accordance with industry and company guidelines
• Handle any complaints associated with a claim
• Adhere to industry regulations and customer quality Treating Customers Fairly
• Follow up on outstanding claims
• Process improvement, contribute to improvement of claims procedures
• Reporting, generating and Analysing claims reports to identify trends

Key competencies

• Detail orientation
• Windows
• Computer literate
• Email etiquette
• Data capturing
• Ccommunication skills
• Handle pressure
• Work independently
• Team member
• Conflict handing
• Empathy
• Flexible
• Change agent
• Solutions orientated
• Analytical thinker
• Extra hours
• Bilingual
• Training
• Organising
• Decision making Level 3 or 4
• Problem solving skills Level 3 or 4

Communication

External

• Customers
• Channels and partners

Internal

• Team members
• Supervisor
• Managers
• Exco members
• EasyPay Group
• Call Centre
• Sales