Intermediate Claims Assessor (Johannesburg/Cape Town)
Pps Group
Gauteng, South Africa
16h ago
source : findojobs-za

Main duties and responsibilities : Claims Assessment : Assessment and management of short-term sickness, critical illness and hospital claimsChecking the technical aspects of the claim, inclusive of potential non-disclosures and exclusionsReviewing all medical information on file, analysing and synopsising the information at handDetermining and recording additional required informationDeciding on referrals to an independent specialistReceiving Independent Specialist reports and analysing and synopsising the report in context of the claim and PPS Provider PolicyChecking and authorisation of claims in terms of published Delegation of Duthority (DoA) Process optimisation and efficiencies : Correspondence with clients with respect to claims outcomes and requirements for future claims in order to manage claimsKeeping accurate records of all claims assessed in accordance with departmental proceduresDealing with first line queries by members and brokers telephonically and via e-mailDealing with Arbitration and Ombudsman cases and collaborating with other stakeholder during the Complaints processParticipating in projects to improve departmental service, owning their role in the project and completing tasks as required by providing input Risk and Compliance : Adhering to internal service level agreements (SLAs) to ensure operational efficiency and achievement of agreed customer service standardsEnsuring adherence to audit requirementsEnsuring adherence to regulatory and compliance requirements People and Culture : Collaborating with relevant stakeholders : Research & Development, Legal, Operational Accounts, Non-Disclosure and Internal ControlContributing and assisting with reviewing processes and protocols where required to assist in PPS’s delivery of quality claims decisionsForging strong working relationships with stakeholders Education : Matric (Grade 12)Medical qualification compulsory (Nursing, Occupational Therapy and Physiotherapy or related) Experience : 3 years’ experience in the Insurance industry2 years’ experience in claims assessment including Income protection, Lump Sum Disability and dread disease Knowledge and Skills : Proficient in the assessment of claimsMust understand claims environment and general claims protocols and processesMust have excellent telephone etiquetteGood computer knowledge - MS Outlook, Excel and Word are necessaryGood report writing and presentation skillsBuilding and maintaining relationshipsCommunication skills (written and verbal)Business writing skillsEffective time management skills Competencies : Must have a mature, disciplined and driven personalityAble to work independently as well as being a good team player with excellent interpersonal skillsDeadline / target-driven, with the ability to work under pressurePlanning and organising with strong attention to detailLogical and analyticalClient centricityResilience Preference will be given to Employment Equity candidates You acknowledge that any information supplied to PPS is provided voluntarily and therefore constitutes unconditional, specific and voluntary consent to the processing of such information by PPS.

Your personal information will be processed for facilitating your application for employment with PPS as well as any statutory or regulatory compliance with which PPS must comply (where applicable) and for the legitimate interests of PPS and the yourself, both during the recruitment process and thereafter.

You may instruct PPS by written notice to cease the processing of your personal information at any time and, subject to the requirements of applicable South African law, request that PPS delete and / or de-identify such personal information.

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