Claims Clerk – Living Benefit Claims (Mozambique)

About the role

The Claims Clerk will assess, review and manage living benefit claims in Mozambique, ensuring compliance with legislation, scheme rules and company policies while meeting service level agreements and client expectations.

Key responsibilities

• Assist the Claims Team Leader and Operations Manager as needed.
• Process health service provider claims submitted within 10 days, following established rules and protocols.
• Perform batch reconciliation and achieve daily/weekly productivity targets.
• Report irregular or suspected fraud cases to the Claims Supervisor and Operations Manager.
• Monitor electronic submissions from health providers via email and system.
• Process South African, in‑hospital and express‑line claims.
• Conduct quality reviews on 5% of processed claims and provide feedback to internal audit.
• Report system errors and coordinate with back‑office support.
• Support monthly reporting for the Claims team.

Required profile

• Grade 12 or equivalent qualification.
• 1–2 years of claims processing experience.
• Strong analytical, communication and problem‑solving abilities.
• High attention to detail and a customer‑focused mindset.

Required skills