Accident Benefits Representative
CurrentKnowledgeable in investigating, verifying and validating; Clarity in identifying loss transfer as well as priority issues, pursuing priority disputes within the regulated timelines.Proficient in analyzing and determining the benefit entitlement with regards to the injuries sustained; ensuring any discrepancies about the claim is flagged as it may lead to high risk. Act quickly & confidently to adjudicate claims while providing excellent customer service with focus on rapport and professionalism to claimant, legal representative, health care provider, and other concerned individuals.Responsible to maintain adequate reserves, avoiding step reserving, for the handling of each claim as per the SABS & company established reserving protocols; assess, calculate and issue timely payment to claimants, clinics and other concerned parties.Efficiently interact within the company system and the industry systems (HCAI) and ensure of no overdue activity therein. Proactively collect, review and document all accident & medical related information with an aim to reach to a file resolution as a fair and reasonable settlement whenever appropriate. A solid performer in the Customer Experience Index (CEI) measuring satisfaction of customers- which is done by 3rd party for the insurer.Handle and prepare files in defence litigation and Alternative Dispute Resolution (ADR).
