Gap Claims Assessor - CPT

SUMMARY:
Gap Claims Assessor

POSITION INFO:
Our client is looking for a detail-oriented and proactive GAP Claims Administrator to join their team. In this role, you will manage and process claims, ensuring accuracy and timely service while maintaining high levels of client satisfaction.
Key Responsibilities:

• Check and validate all GAP claim documents, requesting any missing documents.
• Capture claim information accurately on the system, following the claims process.
• Verify and update client personal information as required.
• Assess claim validity in line with policy terms and conditions, and document claim notes.
• Manage client and broker expectations by applying TCF principles and clear communication.
• Meet daily claim targets with accuracy and within the specified service turnaround time.
• Maintain and update your daily workflow and claim tasks.
• Prioritize and process high-priority claims within 2 hours, as identified by management.
• Interact with medical aids, hospitals, and medical practitioners to gather necessary claim information.

• Strong written and verbal communication skills.
• Excellent negotiation skills and ability to meet customer expectations.
• Solid understanding of medical aid systems and processes.
• High attention to detail with accuracy in administrative tasks.
• Proficient in MS Office (Excel, Word, Outlook).
• Strong time management, planning, and organizational skills.
• Ability to work independently and as part of a team.
• Capable of handling pressure and setbacks with a proactive approach.

• Ability to work under pressure and meet targets.
• Self-motivated with a positive, “can-do” attitude.
• Willingness to assist clients with their claims and requirements.

• Previous experience in medical aid claims processing and administration.
• Experience in the insurance industry is highly advantageous.