Claims Assessor: Life

Claims Assessor: Life

Insurance

DURBAN, KWA-ZULU NATAL
 
PURPOSE OF THE ROLE: Responsible for validating, evaluating, making the correct assessment decision and calculating the correct settlement for CPP (Life) Claims assessed.
 
 
Claims Processing
  • Confirm that the claim intimation is correct and valid.
  • Check the status of the policy & receipt of premium (current and up to date), to facilitate claim processing.
  • Responsible for ensuring that all the required supporting documentation is obtained to comprehensively assess the claim. If necessary, requesting the Claims Administrator to source outstanding documents.
  • Responsible for evaluating and assessing the claim as per the policy wording/requirements documented in the policy wording.
  • Responsible for updating IUA inhouse systems with relevant information and developments throughout the assessment process.
  • Responsible for making the “correct” decision in respect of the claim.
  • Responsible to facilitate the process of claim settlement.
  • Responsible for ensuring the accuracy and completeness of system data relating to the claim to facilitate the accuracy of system generated claim settlement amounts.
  • Responsible for achieving daily performance targets.
  • Responsible for calculating the correct claim amount payable.
 
Administrative Duties
  • Support all involved stakeholders with regard to claim queries.
  • Ensure that all interactions and developments are well documented on IUA inhouse systems.
  • Ensure optimal use of MOS to manage workload.
  • Responsible for generating payment requisitions to facilitate claim payments.
  • Assume overall responsibility for the content of the decision notification sent out to all relevant parties.
  • Will work on the queries on the Assessor 1 queue.
  • Will attend to ad hoc business partner queries.
 
   
Knowledge, Skills and Behaviours:
  • Good understanding of the claims assessment process.
  • Detailed knowledge relating to the specialist/technical nature of life claims assessment.
  • Good understanding of medical conditions and the ability to understand medical terminology and medical reports.
  • Logical and analytical and able to make accurate, complete deductions from multiple sources of information received in respect of the claim.
  • Knowledge of the relevant policies and the ability to understand and interpret relevant policy wordings.
  • Able to make correct and timely decisions as informed by policy wordings.
  • Good communication skills, both written and verbal.
  • MS Office Skills including Excel.
  • High levels of attention to detail to ensure accuracy and completeness.
  • Ability to apply judgement and tact when providing explanations.
  • Ability to manage policy holder expectations.
  • Ability to work independently and demonstrate initiative.
  • Team orientation. Committed to team goals, targets and objectives.
  • Good organisational and time management skills. Able to plan and prioritise in order to meet deadlines.
  • Results focused.
  • Quality orientation.
  • Customer service orientation.
  • Integrity.
  • Empathetic, patient and tolerant.
  • Diplomatic and mindful of impact.
  • Cross cultural awareness.
  • Assertive and confident.
  • Ability to interpret medical reports.
 
   
Education/Experience required:
  • Matric.
  • Minimum Qualification: Relevant NQF 4.
  • A medical qualification would be an advantage.
  • Preferred Qualification: Further Education and Training Certificate (FETC) in Short Term Insurance, Long Term Insurance or Retail Insurance.
  • FAIS Regulatory Exam for Representatives (RE5).
  • At least 2 – 4 years’ work experience as a Life Assessor is required.
  • Previous work experience in long term insurance services, financial services or an insurance company would be most valuable.
  • Relevant technical knowledge to understand the technical requirements of life assessment is required.
  • A good understanding of general financial concepts is required.
 
 
Applications to be sent to nicola@proappoint.co.za with the subject: Life Claims Assessor
Please note that this position is based in Durban, KZN. ONLY shortlisted candidates will be contacted.
Education / Experience