Risk Claims Administrator

Overview

• Salt EB is seeking a meticulous and service-driven Claims Administrator to join our PSSPF Risk Claims team. The successful candidate will be responsible for performing quality assurance QA checks on claims to ensure accuracy, compliance and adherence to Fund rules and service level agreements. The role plays a critical part in minimising financial risk, improving claims processing efficiency and enhancing overall client service delivery. Responsibilities include:

Claims Quality Assurance

• Perform end-to-end QA checks in line with the Fund's Quality Assurance checklist.
• Verify completeness and accuracy of claim forms and supporting documentation.
• Ensure all claim documentation is correctly completed, signed and compliant with Fund requirements.
• Confirm alignment between claim data and system records Everest system.
• Identify and escalate discrepancies or missing information to relevant stakeholders.
• Ensure all mandatory supporting documents are received and compliant.
• Conduct due diligence checks including verification of member details ID, name, DOB, tax number, banking details and employer information.
• Identify outstanding loans or indebtedness in line with applicable legislation Section 37D / Section 195a.
• Perform member and beneficiary bank account verification after workflow loading.
• Check for possible matches on the Unclaimed Benefit Fund register.

Record Keeping and Filing

• Maintain accurate and complete records on the Everest system.
• Ensure all correspondence is properly attached to member/deceased member files.
• Capture accurate case notes and updates on the system.

Query resolution

• Respond to internal and external email and telephonic queries efficiently and professionally.
• Liaise with Client Services, Contact Centre, Compliance, employers, and service providers to resolve queries.
• Provide continuous feedback until queries are fully resolved.
• Attend to escalations within 24–48 hours.
• Support Contact Centre and Claims Administrators with information and documentation requests.

Performance & Productivity

• Meet daily production target of 30 cases per day.
• Maintain an error rate of less than 1%.
• Ensure high levels of accuracy, efficiency and compliance under pressure

Team Support

• Contribute positively within the team environment and support colleagues where required.
• Take accountability for allocated work and deliver within agreed timelines.
• Participate in projects and additional business initiatives as required.
• Work overtime when operationally required

Relationship Management

• Build and maintain strong working relationships across internal departments and external stakeholders.
• Promote a professional, responsive, and client-centric service culture.
• Uphold the company's reputation, values, and service standards at all times

Time Management

• Excellent time management
• Must be available to work overtime when the need arises.
• Flexible and ability to work under pressure and multitask.
• Accuracy and attention to detail
• Strong decision-making and analytical thinking
• Effective communication and interpersonal skills
• Time management and organisational ability
• Conflict management and negotiation skills
• Ability to work independently and in a team
• Commitment to compliance and ethical standards

Required Qualifications & Experience

• Matric Grade 12
• Proficiency in Microsoft Excel
• Knowledge of FICA, POPIA & Treating Customers Fairly TCF principles
• Strong written and verbal communication skills
• Experience in employee benefits / claims administration advantageous
• Strong attention to detail and analytical ability
• Ability to work under pressure and meet strict deadlines
• Strong stakeholder engagement and customer service skills