Job Summary:
Accurately assess Pet Insurance claims submitted for Veterinary facilities. Provide support and education to clients and appropriate vendors/providers relating to claims queries, processes, and the policy. Project a professional company image through omni-channel interaction.
Key Duties & Responsibilities:
Claims Assessing:
Timeous and accurate assessing of claims (30 claims per day minimum).
Assist when additional help is needed on queues to keep them live, assist with overflow as directed by team leader and/or supervisor.
Authorization of Hospital claims as per policy terms and conditions.
Inform customers/providers in a professional manner regarding invoices that will not be accepted or specific claim requirements.
Follow-up on customer/provider inquiries not immediately resolved, within determined SLA's.
All client communication to be professional and accurate.
Answer phones and respond to customer requests within the determined SLA.
Explain products and update customer details in the computer system.
Provide customers with product and service information via appropriate methods.
Follow and adhere to claims/company processes, procedures, and protocol.
Recognize, document, and alert the supervisor of trends in customer calls/claims.
Recommend process changes and/or improvement suggestions.
Focus on first call resolution as far as possible.
Answer WhatsApp chats with customer requests within the determined SLA.
Transfer customer calls to appropriate staff, where necessary.
Conduct outbound calls as required to ensure the client is informed and updated on the progress/status of the claim.
Ensure daily stats are manually tracked and updated on the daily spreadsheet.
Assess claims according to standard operating procedure and company protocols.
Improve client service experience and create engaged clients.
Handle complex and escalated client service issues.
Identify any potential errors or obstacles that may arise which might impact client experience.
Demonstrate the Oneplan Values and Culture in all engagements.
Display leadership through your actions by accepting responsibility for daily deliverables.
Support cross-functional work areas targeted to resolve issues raised.
Underwriting:
Pet image validation- queue to be cleared daily.
Request regularly for updated pet images.
Accurately Underwriting of new dependents according to protocol.
Additional tasks:
Be available and willing to assist with any additional tasks and projects as required.
Conduct outbound calls to ensure client is informed and updated on the progress/status of the claim.
Claims Queries:
Log every call/query received/made.
Identify, research, and resolve customer issues using the CRMS.
Complete call logs and reports.
Educate clients on claims process and general claims queries.
Assist and resolve claim queries and client complaints.
Quality, Consistency, and Compliance:
Maintain standards as per CSAT, QA Call metrics, and claim assessing score.
Timeous answering of chats within specified SLA.
Deliver quality service by providing efficient, quick, and friendly service to clients.
Ensure adherence to standard operating procedures and demonstrate exceptional product knowledge.
Work Collaboratively:
Build a culture of respect and understanding across the organisation.
Facilitate opportunities to engage and collaborate with stakeholders.
Self-Management and Time Management:
Demonstrate consistent application of internal procedures.
Plan and prioritise, demonstrating abilities to manage competing demands.
Demonstrate flexibility in balancing achievement of objectives.
Key Requirements of the Role:
Grade 12 with English and a second language.
RE5 (preferred).
Relevant qualification in a related field advantageous.
Minimum of 2-3 years Customer Service and Claims experience (preferably Pet Insurance).
Meet FAIS fit and Proper requirements.
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