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
Logical and analytical
Attention to detail
Excellent verbal and written communication skills
Confident decision making
Insurance industry knowledge
Report writing skills
Initiative and Forward Thinking
Ability to travel on an ad hoc basis
Attractive salary on hand.
Please apply online and we will contact you to discuss further.