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 :
Your skills and character traits :