Claims Officer

at  Allianz Partners

KEY REQUIRMENTS/ WHAT YOU BRING :

• 1-2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Proficiency in MS Office
• Completion or progression towards the Diploma in Private Medical Insurance.
• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
• Team player
• Physically fit to carry out duties.
• Ability to demonstrate sounds work ethics.
• Ability to work under pressure and to meet tight deadlines and service standards

• Adjudicate and process Claims within the agreed company SLA - clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target
• Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning
• Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention
• Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided.
• In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims
• Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction
• Participate in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills
• Assume additional tasks to effectively support the Team Leader to deliver on team KPI’s and deputise for Team Leader, as needed
• Give support and guidance on escalated issues, complaints and challenging claims and lead by example
• Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
• Ensures that high quality targets (standard of work performance) are achieved at all times.
• Support your Team Leader to drive engagement within the Team
• Other Ad hoc duties as required