Claims Administrator

Job Title

The Claims Administrator II is responsible for supporting the efficient processing of claims within the Financial Services environment. This includes managing customer queries, assisting with administrative tasks outside core systems, and coordinating with internal and external stakeholders to ensure smooth claims operations. The role also contributes to service level improvements and compliance with established procedures.

Requirements

• Grade 12 (Matric).
• Diploma or Certificate in Business Administration, Insurance, Customer Service, or a related field will be advantageous.
• 2–3 years' experience in claims administration, insurance administration, or a customer service environment.
• Experience working with insurance claims and policy administration.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Experience working with CRM/CSM systems will be advantageous.

Skills and Competencies

• Excellent communication and interpersonal skills.
• Strong customer service orientation.
• High attention to detail and accuracy.
• Strong problem-solving and conflict resolution skills.
• Good organisational and time management skills.
• Ability to work under pressure and manage multiple priorities.
• Strong administrative and data capturing skills.
• Ability to work independently as well as within a team.

Key Duties

• Update product benefits when changes are requested by customers or following the outcome of an insurance claim.
• Manage customer disputes and queries relating to insurance products and claims.
• Issue policy documents, process insurance premium refunds, and manage policy cancellation requests.
• Handle insurance claim benefit-related queries and disputes.
• Manage incoming customer calls and accurately capture requests on the CSM system.
• Process and manage substitution requests on the CSM system.
• Liaise with customers across multiple communication channels, including telephone, email, SMS, and WhatsApp.
• Process claim payments and authorisations in accordance with policy terms and conditions.
• Reconcile claims payments to ensure accuracy and compliance.
• Manage device rental customer queries, including premium collections, claim initiations, and cancellation requests.
• Maintain accurate customer records and ensure all administration is completed in line with company policies and service level agreements.
• Deliver exceptional customer service while maintaining a high level of professionalism.

Preference

Preference will be given, but not limited to candidates from designated groups in terms of the Employment Equity Act.