• Creating new and subsequent claim records and updating these records as each claim progresses.
• Responding to claims notification.
• Following internal guidelines to aid claims processing.
• Identifying valid and invalid claims by analysing the terms and conditions of the policy contract and the claim information.
• Liaising with policyholders, veterinary surgeons and loss adjusters to ensure thorough assessment of liability.
• Answering and responding to telephone calls/emails or making outbound telephone calls 
• Resolve queries and gain information necessary for the expedient assessment of each claim.
• Updating the policyholder accordingly where applicable.
• Authorising instructions to repairers, loss adjusters/referral and consultant vets.
• Working to reduce hard and soft leakage.

Skills: Independent Authority Management, Advanced Decision-Making, Exceptional Customer Service, Comprehensive Claims Handling, Regulatory and Compliance Adherence, Fraud and Non-Disclosure Detection, Process Optimization, Effective Stakeholder Communication

• Act independently within agreed authority and service levels. 
• Decision-making authority is an essential requirement.
• Provide exceptional levels of customer service to policyholders, clients and intermediaries in a professional and friendly manner.
• Manage the claims relationship for all customers within the agreed portfolio.
• Ensure all aspects of the claims function, including complaints, are dealt with in accordance with all compliance, CBI, FCA, TCF and legal requirements.
• Identify and investigate potential non-disclosure claims.
• Identify and investigate potentially fraudulent claims.
• Identify process issues and propose solutions for improvement within the agreed business framework.
• Liaise with the Chief Medical Officer, underwriters, and external service providers to ensure all appropriate information is obtained 
• Assist in the assessment and ongoing management of claims.

Skills: Independent Decision-Making, Customer Service Excellence, Claims Management, Regulatory Compliance, Fraud Detection, Process Improvement, Stakeholder Liaison, Claims Assessment

• Assist with the management of SCT and AFCA complaints
• Encourage innovation and active participation in problem-solving and process improvement.
• Calculating claims settlement / offers of settlement.
• Assessing future risks presented by the loss(es) within guidelines.
• Maintaining individual and team targets.
• Dealing with referrals from all Departments.
• Rotate and undertake all duties and identifying recoveries.
• Maintain a good working relationship with Reinsurers in order to maximize recovery from reinsurance contracts.
• Provides claim sign-off for colleagues.
• Manage claim appeals within the agreed process and authority level.

Skills: Complaint Management, Innovation Promotion, Settlement Calculation, Risk Assessment, Target Management, Interdepartmental Coordination, Duties Rotation and Recovery Identification, Reinsurer Relationship Maintenance

• Review, assess, and approve health, medical, critical illness, disability, accident claims within service turnaround time.
• Ensure output is accurate and compliant with internal policy and regulatory requirement and meet service objectives
• Attend to service recovery, complaint, appeal, inquiry
• Supervise and set priorities for the team and manage claims investigation
• Coach, supervise, and guide subordinates in providing accurate and prompt services to advisers and claimants
• Conduct medical claims technical workshops for agency force
• Identify process shortcomings and implement improvement
• Plan and organize resource and headcount for business needs
• Manage working relationships with external parties - CPFB, auditor, regulator, agency leaders, bancassurance partners

Skills: Claims Approval, Compliance Assurance, Service Recovery Management, Team Supervision, Coaching and Guidance, Workshop Facilitation (Medical Claims), Process Improvement, Resource Planning

• Review of plan member or dependent coverage and eligibility
• Confirmation of the contract provisions in effect for each claim
• Verification of enrolment and beneficiary information
• Review of proof of death (loss) documents
• Review of supporting medical/ police/ investigative reports
• Calculation of eligible benefits and delayed interest
• Preparation of claims system records, necessary to record and pay the claim.
• Communicate decisions to claimants or beneficiaries, and group clients
• Assist plan sponsors with queries regarding beneficiary appointments on enrolment, and requirements for submission of claim
• Provide support to beneficiaries/ family members in obtaining necessary documentation.

Skills: Eligibility Review, Contract Confirmation, Beneficiary Verification, Document Analysis, Benefit Calculation, Record Preparation, Decision Communication, Beneficiary Support

• Strong computer Literacy (MS Word, Outlook and Excel)
• Experience in medical aid or gap cover claims processing and assessing 
• Experience in insurance 
• Basic knowledge of the local health and medical schemes industry
• Basic knowledge of awareness of demarcation and legislation governing the local health industry.
• Excellent written and verbal communication skills.
• High level of accuracy, with a strong attention to detail.
• A thorough, analytical and methodical approach to work
• Can be confident and decisive with claim cases
• Previous experience working in a veterinary or pet insurance organization 

Qualifications: BA in Finance with 2 years of Experience

• Good understanding of travel insurance product benefits and limitations
• Good understanding of system processes and workflows
• Comprehension of healthcare systems and billing practices
• Excellent verbal and written communication [both English and French], other languages such as Spanish are an asset
• Proficiency in the Microsoft suite products
• Strong decision-making skills and attention to detail
• Good organizational skills and ability to prioritize.
• Experience in a customer service-related position within the insurance sector.
• Team player, mature, with excellent leadership quality.
• Good knowledge of hospital admission, discharge, and claims processes.

Qualifications: BA in Legal Studies with 2 years of Experience

• Customer service focus is essential
• Having the ability to problem-solve
• Have high attention to detail
• Excellent verbal and written communication skills
• Have basic awareness of dog and cat terminology
• Good medical knowledge and claims settlement procedure.
• Experience in a claims or underwriting function in a Life Assurance Company
• An interest in helping people and in securing the correct claim outcomes for customers.
• An understanding of risk claims processes.
• Highly organised and self-motivated individual with an ability to prioritise effectively, work both independently and as part of a team.

Qualifications: BA in Insurance and Risk Management with 5 years of Experience

• Experience and exposure in handling relevant claims, specifically Group Income Protection and Life claims 
• Able to demonstrate technical ability with claim assessment and decision-making.
• Knowledge of Medical or Scheme Underwriting would be beneficial.
• Claim decision-making authority is an essential requirement, either from previous experience or awarded by MetLife.
• Confidence in communicating claim decisions via the telephone and in writing.
• Articulation and eye for detail, to be capable (with existing experience or after training) of quality checking and giving feedback on the work of others.
• A fondness for learning
• Good product and regulatory knowledge.
• Good working knowledge of internal procedures and standards.
• Good organizational and planning skills, including planning own workload.

Qualifications: BA in Health Sciences with 3 years of Experience

• Experience specifically with Group Benefits
• Previous Life Claims experience is highly 
• Understanding of medical terminology
• Ability to interpretation of contractual wording
• Excellent communication skills with the ability to influence internal and external clients at all levels
• Ability to demonstrate empathy for grieving families
• Strong Microsoft Office skills (Outlook, Skype for Business, MS Word, and Excel)
• Ability to recognize quickly what needs to be done in order to satisfy the expectations
• Proven analytical, organization, time management, and decision-making skills
• Ability to work effectively individually and with a team
• Proven ability to prioritize and meet deadlines and specific turn-around times
• Flexibility to adapt to change and work additional hours as business needs 

Qualifications: BA in Business Administration with 2 years of Experience