Senior Claims Assessor - Cape Town
PNet (Pty) Ltd
Cape Town
6d ago

Senior Claims Assessor

Key Areas of Responsibility

  • Technically and medically assess validity of claims.
  • Assess Long-term claims across all claim types (Disability, short duration sickness claims, Permanent Incapacity claims).
  • Evaluate claims and determine requirements for future management and for decision by Medical Officers Committee.
  • Prepare communication to members and medical specialists.
  • Analyse and synopsise medical reports and other information in context of claims and the Provider Policy.
  • Presentation of claims at Medical Officers Committee.
  • Provide input on future management of all potentially long term claims, inclusive of potential rehabilitation and return to work programs.
  • Keeping accurate records of all claims assessed in accordance with departmental procedures.Resolve escalations and complaints.
  • Participation in projects to improve departmental service delivery.
  • Conduct member visits and do work site visits providing a formal report following each visit conducted.
  • Appoint rehabilitation specialist in accordance to a set criterion.
  • Approve case management programs of intermediate and junior assessors.
  • Guide and support junior and intermediate assessors.
  • Provide input into assessment protocol.
  • Authorize claims in line with their Delegation of Authority.
  • Minimum Requirements :

  • Matric (Grade 12)
  • Degree in Occupational Therapy or Physiotherapy or equivalent
  • Must have at least 5 years working experience, 3 of which must be in the Life Insurance Industry.
  • Income protection, Lump Sum Disability and dread disease claims assessment at a Senior level is a requirement
  • Case Management experience is an advantage
  • Fluent in English both written and verbal
  • Must have excellent communication skills
  • Good computer knowledge - MS Outlook, Excel and Word are necessary
  • Accountability
  • Logical and analytical
  • Attention to detail
  • Excellent verbal and written communication skills
  • Confident decision making
  • Insurance industry knowledge
  • Report writing skills
  • Leadership skills
  • Initiative and Forward Thinking
  • Relationship building
  • Ability to travel on an ad hoc basis
  • Attractive salary on hand.

    Please apply online and we will contact you to discuss further.

    thank you.

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