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Claims Officer

Job Description

Claims Officer

Our client is the only international health insurance provider to offer a 48-hour turnaround on submitted medical claims, under its “Clear to Zero” claims handling initiative. With a 95% client retention rate and a customer base that includes many of the Fortune Global 500 companies, our client continues to build a reputation for service excellence in international healthcare.


The successful candidate will have the opportunity to work in growing multicultural company committed to empowering its employees and furthering their development. A competitive remuneration and benefits package is offered, including healthcare, pension, life & disability, travel subsidy, discounts on home and car insurance, sports & social club and support for professional studies.


Key Responsibilities 

·  Adjudicate and process Claims within the agreed company SLA -  clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target

·  Use client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning

·  Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention

·  Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided.

·  In line with the company’s policy on cost containment identify duplicate payments, possible non-disclosure and fraudulent claims

·  Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction

·  Participate in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills

·  Other Ad hoc duties as required 



Experience Required 


· Previous experience in a customer focused role, in an administrative capacity

·  Experience working in pressurised environment with tight deadlines

·  Fluency in English + 2nd language is essential to this role


Behavioural Competencies 

  • Customer focused
  • Strong communication (verbal & written)
  • Ability to work effectively within a team environment
  • Honesty and Integrity
  • Ability to work under pressure
  • Results driven and solution oriented


Technical Competencies 

·         Strong Knowledge of Microsoft Office (Excel, Word)



Ref: 00000


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