Claims Clerk – Mozambique

About the role

The Claims Clerk will join the Claims Team in Maputo, supporting the assessment and processing of living benefit claims for health services. Working remotely, you will ensure claims are handled in line with legislation, product rules, and company policies while meeting service level agreements.

Key responsibilities

• Process health service provider claims submitted within ten days.
• Assess claims according to established rules and protocols.
• Perform batch reconciliation and achieve daily/weekly productivity targets.
• Monitor electronic submissions and manage South African and in‑hospital claims.
• Conduct quality reviews on 5% of processed claims and provide feedback.
• Report system errors, suspected fraud, and irregular cases to supervisors.
• Support the Claims Team Leader with monthly reporting and claims express line management.

Required profile

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

Required skills

• None specified

What we offer

• Permanent employment with a reputable financial services group.
• Remote work arrangement.
• Opportunities for professional development in claims and insurance.