Life Claims Assessor x10
Energy at Work Projects
Johannesburg, Gauteng, ZA
4d ago

Financial Services Leader urgently seeks to appoint 10 skilled Life Claims Assessors on a 12 month contract.

Purpose of the role :

To effectively assess valid Death / Disability / Dread Disease / Retrenchment and Hospital Plan claims, on

non-underwritten products, accurately within specified turnaround times.

Duties and Responsibilities :

Accountability : Assessment of claims

  • Access claims daily by logging into the administration system
  • Ensure that the submitted documentation is clear and authentic. Verify the Life assured and claimant through
  • checking the details on the relevant Systems as well as against the client’s application form and Policy documents.

  • Ensure every claim is assessed in accordance with the relevant policy terms and conditions.
  • Contact the relevant third parties for required information (e.g. Police, medical personnel, medical aids,
  • employers, clinics, hospitals, etc).

  • Identify suspicious claims and refer to the forensic investigator for further investigation.
  • The assessor is responsible to make the decision on each claim and to motivate these decisions.
  • Refer claims to the ex-gratia committee with a motivation where claimants request under exceptional
  • circumstances.

  • Where applicable refer claims to unclaimed benefits.
  • Accountability : Customer experience

  • Handle all walk in clients and telephone queries in a professional manner. If required transfer all non-claims
  • related queries to the relevant and correct department.

  • Inform branch consultants and claimants when documents are received of any outstanding documents or claim
  • decision.

  • Ensure that clients are advised in communication of the final decision what the status of the benefits claimed
  • against are, or if policy is ended due to the claim.

  • Advice of claimant of the period of payment when monthly payments are made.
  • All letters must be referred for authorizing before posting to the claimant.
  • Produce all correspondence to the highest quality according to standards.
  • Take responsibility and ownership off all queries received and finalize them speedily according to the SLA and
  • turnaround time.

  • Do regular follow ups on outstanding documentation needed for pending claims.
  • Minimum Requirements :

  • Matric
  • Minimum of 4 years experience with specific understanding of the life insurance market
  • All appointments will be made in line with company EE requirements.

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