Administrator: IL Claims Assessment
Assupol Life Limited
Menlyn (Gauteng)
2d ago

Specification Duties & Responsibilities :

1. Assessing and processing of life and funeral claims

  • Process funeral and life claims and prepare for claims approval process within 48hrs of receipt
  • Verify premiums paid on the system prior to assessing claims
  • Verify deceased and beneficiaries against main policy on the system
  • Confirm the policy holders relationship to the deceased
  • Liaise with Re-insurers where necessary on Life cover policies below R300 000.00
  • Refer suspicious fraudulent claims to Specialist administrator
  • Discuss complex claims with in-house professional advisor and consultants
  • Follow up timeously on all outstanding claims
  • Liaise with relevant stakeholders on outstanding and incorrect Id numbers and where the person is covered on the application form but does not exist on the system
  • Liaise with Client services where the deceased died before the policy become inactive. To activate the policy prior to assessing
  • Responsible for identifying disputes and complaints of complex claims
  • Recommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expires
  • Update AIMS notes on system
  • Be a 2nd validator on captured and authorized claims
  • Give feedback on follow-up claims to Section leader
  • Forward a spread sheet of all finalized claims to Section Leader
  • 2. Claims pay-out

  • Confirm status of the claim if it is approved or declined
  • Where the age of the deceased differ with the one on the system apply the penalty formula
  • Recommend decline / payment of claims
  • Double check the consistency on banking details attached to the claim and the one on the system
  • Forward the claim to Manager for payment
  • Check the finance list and sign off
  • 3. Reconcile information received, processed and finalised

  • Compile monthly individual statistics
  • Compiling all branch registers month end (Death)
  • Present challenges experienced and solutions taken to resolve them
  • Requirements 1. Formal Education

  • Matric
  • 2. Technical / Legal Certification

  • NQF 4 in Insurance (Advantage)
  • 3. Experience

  • 2 years life insurance
  • Legislation
  • Life Insurance Industry
  • Long Term Insurance Claims
  • 5. Skills

  • Computer Literacy
  • Communication
  • Analytical
  • Problem Solving
  • Interpersonal
  • 6. Attributes

  • Assertiveness
  • Team Player
  • Attention to detail
  • Planning & Organizing
  • Control Procedures
  • Apply
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