Key Tasks: 

Payments are made in a timeously manner according to SLA: 

• Hospital claims paid within 24 hours of assessment. 

• Funeral claims paid same day as assessment. 

• Day-to-day claims paid weekly within SLA. 

• Receipt of payment advice and allocations to correct claim. 

• Resolution of internal and external queries within SLA. 

• Service providers / disbursements are paid with SLA. 

Accurately validating claims as per set out procedures:

• Check claims to prevent potentially fraudulent activities. 

• Ensure claim values are calculated correctly. 

• Ensure claim limits are calculated correctly. 

• Perform policy validation. 

• Distinguish between insurer claims and WCA related claims. 

Ensure an accurate and up-to-date record is kept of all payments made: 

• All claims’ registers are updated daily. 

• Accurate capturing of Service providers / disbursements on the system. 

• All payments are reconciled daily as per set out procedures. 

Ensure month-end reporting is completed timeously and according to SLA:

• Accurate compilation of Financial Claims month-end reports. 

• Ensure reports are submitted for review with SLA. 

• Ensure accurate claims reporting.