claims processor: Center reason for the job:
to pay off claims from third parties and recover money from them in order to cut costs and improve the company’s profitability.
Location: Isando, Johannesburg (office based position)
Compensation: Negative R23,000 per month, plus benefits (pension and contribution to medical aid).
About the organization:
Work five days a week five kilometers from OR Tambo International Airport in a beautiful and harmonious office with people who are driven and focused.
There are numerous opportunities to surpass KPIs within SLA.
Admittance to dynamic and steady worker authority and word class organization culture inside a youthful JSE recorded organization that is a forerunner in cutting edge portability arrangements.
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claims processor
Utilizing a web-based, world-class, omnichannel, single-user interface claims system, thrive in a digital workspace.
Requirements Academic qualifications Valid driver’s license Relevant post-matric qualification (advantage) Work experience of two to three years related to claims recovery (MVA – Motor Vehicle Accident Claims) Apportionments Negotiation of claims Uninsured insurance collections Knowledge Case law, merits, and apportionments Vehicle parts, repair quotations, and assessments Role Review motor vehicle claims
Every day, look over the assigned claims portfolio. claims processor
Quantum, Insurance, Merits, and Prescription claims should be given priority.
Establish, expand, and keep valuable claims processor partnerships in the Claims industry. claims processor
Upload supporting documents to the DMS if necessary and verify them against the digital checklist.
Determine the degree of liability, evaluate the merits of each claim, and finish the claim calculation for Recovery. claims processor
claims processor
Send the LOD generated by the system.
Keep track of comments, third-party consultations, and sub-status updates.
Upload the releases to the DMS, note the payment date, and so on.
To exceed KPIs, bank money proactive within SLA.
Skills Computer, technology, and systems skills (basic MS Office) Well-developed negotiation and communication skills with third parties, as well as internal resilience (EQ) and interpersonal skills. Written comprehension and reasoning skills. Numerical checking and reasoning skills. Broad problem solving skills. Spatial reasoning skills. Personal Attributes Attentive to detail. Preference for planning and organizing. Focus on getting things done. Concern for working within parameters. Focus on communicating clearly. Focus on persuading. claims processor
Preference for practical thinking Focus on initiating action Appreciation for challenging others with respect Preference for working in a team Competencies Examining information Convincing others Keeping calm Meeting deadlines Checking things Following procedures Managing tasks
Reporting realities
Deciphering information
Taking on pragmatic methodologies
Testing thoughts
Group working
Key expectations and results
Installment Interaction
Demand installment from finance division and get confirmation of installment inside 15 working days.
All third-party payments must be reconciled with the cash book, and a daily allocation request (recoveries) must be sent to Finance. Ensure that all customer liability refunds are requested daily.
Planning an operational diary to accept daily new claims from Claims Administrators
Ensure that all overdue files are attended to and that all files on the daily diary are attended to.
Every day, view and act on files.
Update Natural File preparation files daily with progress comments. Determine if all documentation is accounted for; if not, send a draft or requisition letter to the third party and a letter of demand to the third party.
Appoint an assessor based on the merits of the third-party case (quantity greater than R10,000); update liability codes in accordance with the case’s current status; check the file for any potential breaches and prepare them; then, send them to the National Damage Admin Supervisor for settlement.
Make a proposal for a settlement.
Allude all settlement offers got for endorsement to Cases Administrator
Discussion
Draft settlement offer and ship off outsider
Assuming that settlement is acknowledged by outsider, demand installment upon marked discharge.
Assuming settlement is dismissed, arrange agreements with client.
Draft letter of interest in view of quantum estimation and arrange settlement with outsider in light of legitimacy appraisal.
Litigation Make a litigation file and send it to the manager for approval (recoveries). Receive and give the manager the summons.
Acknowledge Attorney’s receipt of summons. Determine whether all documentation is in the file if none was requested.
Get authorisation for reexamined settlement from Cases Director and Manager
Send modified settlement encourage to outsider Lawyer.
