Life Claims Consultant (Assessor) (individual Claims)
Execuplace Appointments
5d ago
source : Job Placements

Job Description

What you’ll be doing if you get the job :

The purpose of this role is responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims.

Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and accurate decisions on claims worked on.

Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work.

Who’ll you report to :

You’ll be based at our head office in Sandton, Johannesburg. You’ll report to the Head of Claims responsible for Claims.

Your qualifications :

Grade 12 (Essential)

Relevant tertiary qualification; a medical degree preferable

Your Outputs (include but is not limited to) :

Evaluate claims forms and supporting documentation in preparation of making an payment decision

Gathering information and various types of reports from medical practitioners

Compare the reports to our existing claims criteria to establish if claim is payable

Decide on levels of provisions to be raised based on information received

Writing claims assessment standards / policies

Auditing / QA of work done by peers

Deliver claims payment decision

Determine requirements / documents required to evaluate claims

Liaise with relevant re-insurers to determine validity of claims and get their approvals where required

Explain and communicate final decisions to brokers and clients

Create schedules for payments and obtain relevant approvals

Your experience :

  • Minimum 2-3 years experience as a claims assessor
  • Experience in both group and life individual life claims (Essential)
  • Sound Business and Operational knowledge of Insurance Industry administrative processes
  • Good knowledge of the business administration platforms
  • Familiar with Compliance Processes and Procedures in the Insurance Industry
  • Familiar with the business products and their rules and workings
  • Familiar with the business products and their rules and workings
  • Your skills and character traits :

  • MS Office and PC literate
  • Accurate Typing Skills
  • Excellent verbal and written communication skills
  • Quality driven
  • Ability to pay attention to detail as accuracy is important
  • Using effective interpersonal skills to resolve conflict situations
  • Ability to work effectively with others and contribute to team task accomplishment
  • Ability to multi-task and manage multiple priorities
  • Have the ability to operate effectively under pressure
  • Task and deadline orientated
  • Analytical mind and above average problem solving techniques
  • Strong sense of ownership
  • Pro-active and innovative
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