Claims Validator/Assessor (JHB Hybrid)

ENVIRONMENT:

A provider of tailored Financial Solutions seeks a highly meticulous Claims Validator/Assessor to ensure a seamless process for clients. You will be responsible for the preparation, validation, and finalisation of all registered claims - ensuring efficient and effective settlement of registered claims within the terms of the relevant Policy wording, agreed quality standards and business rules. You will also actively manage the validation of claims which need to be paid, repudiated, or forwarded to the awaiting info queue. Applicants must have Matric/Grade 12 with 3-5 years Claims Assessment / Validator experience and must be able to communicate in English, Afrikaans and Zulu/Setswana.

DUTIES:

• Handle claim queries received from Claims Assessors, Supervisor, or Manager.
• Assist clients with claims queries or concerns.
• Liaise with the Claims Assessor and advise them of any issues that arise.
• Meet the required production levels and quality standards, assigned to them by their Supervisor, and their Manager.
• Handle the validation of captured and registered claims.
• Pay attention to detail when validating claims.
• Prepare the reconciliation of validated claims which need to be paid at the end of the day.
• Manage and prepare the daily claims metrics reports.
• Adhere to processes, scripts, and standard operating procedures (Q.A).
• Validate claims on Dionysus.
• Assist with training and upskilling the team across assessments, declined claims, and fraud identification and investigation.
• Ensure great customer service for the client.
• Liaise with their team members and interdepartmental team members on Claim queries on behalf of the member.
• Actively manage all aspects of the claims validation process.

REQUIREMENTS:

• Matric/Grade 12.
• 3 - 5 Years of Claims Assessment / Validator experience is required.
• Microsoft Office.
• Must understand the importance of providing the customer/ member with good service and settling claims on time.
• Good communication skills.
• Punctual, dedicated, hardworking, quick learner and honest.
• Able to communicate in English, Afrikaans, Zulu or Setswana and an added bonus if they can speak Xhosa, Tsonga or Venda.
• Good listener.
• Team player.
• Someone not afraid to work extra hours/overtime if need be.