Risk Claims Administrator

Salt Employee Benefits

Bellville, Western Cape

Full-time

Posted 4 hours ago

Full-time Finance & Accounting

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Job Description

Overview:

Salt EB is seeking a meticulous and service-driven Risk Claims Administrator to join their Belville (Cape Town) office’s Claims team. The successful candidate will be responsible for performing quality assurance (QA) checks on monthly risk billing schedules, to ensure accuracy, to collate and process risk benefit claim packs, liaise with the risk re-insurer around billing information as well as claim packs and act as liaison between the clients, members and risk re-insurer. The individual also must ensure compliance and adherence to risk scheme terms, conditions and rules as well as adhere to service level agreement timelines. The role plays a critical part in minimising financial risk, improving claims processing efficiency and enhancing overall client service delivery.

Claims Quality Assurance:

Perform end-to-end QA checks in line with the administrator’s Quality Assurance checklist.
Verify & ensure completeness of claim pack by ensuring accuracy of claim forms and supporting documentation submitted by claimants (scheme members).
Ensure all claim documentation is correctly completed, signed and compliant with Scheme requirements.
Confirm alignment between claim data and system records (Everest administration system).
Identify and escalate discrepancies or missing information to relevant stakeholders.
Ensure all mandatory supporting documents are received and compliant.
Conduct due diligence checks including verification of member details (ID, name, DOB, tax number, banking details and employer information).
Identify outstanding loans or indebtedness in line with applicable legislation (Section 37D / Section 19(5)(a)).
Perform member and beneficiary bank account verification after workflow loading.

Record Keeping and Filing:

Maintain accurate and complete records on the Everest system.
Ensure all correspondence is properly attached to member/deceased member files.
Capture accurate case notes and updates on the system.

Query resolution:

Respond to internal and external email and telephonic queries efficiently and professionally.
Liaise with Client Services, Contact Centre, Compliance, employers, and service providers to resolve queries.
Provide continuous feedback until queries are fully resolved.
Attend to escalations within 24–48 hours.
Support Re-insurers’ Claims Administrators with information and documentation as may be required in terms of claim and distribution resolution.

Performance & Productivity

Meet daily production target as set out by claims manager.
Maintain an error rate of less than 1%.
Ensure high levels of accuracy, efficiency and compliance under pressure

Team Support

Contribute positively within the team environment and support colleagues where required.
Provide assistance and support to other departments when required to meet operational needs and ensure business continuity.
Take accountability for allocated work and deliver within agreed timelines.
Participate in projects and additional business initiatives as required.
Work overtime when operationally required.

Relationship Management

Build and maintain strong working relationships across internal departments and external stakeholders.
Promote a professional, responsive, and client-centric service culture.
Uphold the company’s reputation, values, and service standards at all times

Time Management