Claims Officer

Key responsibilities will include, but are not limited to, the following/ what you do:

- 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

Requirements: