Claims Officer
7 months ago
Claims Officer
**JOB DETAILS / ROLE PURPOSE** The role of Claims Officer involves processing medical claims for clients worldwide. We ensure a high level of client service while processing claims within an industry leading 48 hours. The Claims Department is a very fast paced and challenging environment, with many different languages used and a mixture of cultures.
**KEY RESPONSIBILITIES** Key responsibilities will include, but are not limited to, the following:
- 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 AWC's 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, 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
- Other Ad hoc duties as required
**KEY REQUIREMENTS**
- 1-2 years' experience in a customer focused environment, ideally in clinical, paramedical or medical 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.
- Ability to work under pressure and to meet tight deadlines and service standards
Job ID 41211
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