Health Claims Settlement Officer

Key Responsibilities

Brief Description of Duties

Claims Processing

• Execute the full claims process in accordance with the Schedule of Benefits for local claims
• Processes, Life, Critical Illness and Accidental Death & Dismemberment Claims.

Administration

• Prepare Pre-certification Letters in accordance with Schedule of Benefits
• Cancellation and reissuing of lost and/or stale dated cheques
• Negation and re-processing of claims

Customer Support

• Ensure the customer is treated fairly and that the customer receives excellent service in accordance with industry and Company guidelines
• Manage any complaints associated with a claim in accordance with CX Guidelines
• Ensure compliance with legal and industry regulatory requirements and customer quality standards set by the Company. 
• ·         Responds to both internal and external clients/customers queries.

Key Competencies

Desciption

1. Insurance Principles and Practices

Represents the individual’s knowledge and understanding of the core principles of insurance and how this is applied on a day to day basis

1. Insurance Products and Services

Represents an individual’s knowledge and understanding of the range of insurance products and services available in the market and how that knowledge can be

used to meet client needs.

1. Compliance and Operational Risk Knowledge

Represents an individual’s knowledge and understanding of regulatory requirements and how to meet these on a day to day basis. It is also about understanding the

concept of operational risk and how this is controlled within organisations.

1. Claims Knowledge

Represents an individual’s knowledge of how claims should be handled and managed

1. Company Market

Knowledge

Represents an individual’s knowledge of Beacon and the wider insurance market place and how this is applied on day-to-day basis.

1. Underwriting Management

Knowledge and understanding of the factors that affect the performance of the portfolio and how risk exposure can be monitored and controlled.

1. Claims Management

This competency is about being able to manage claim cost effectively, minimizing claims leakage, and meeting Organizational and customer claims service standards