Description:
What youll 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. Wholl you report to: Youll be based at our head office in Sandton, Johannesburg. Youll report to the Head of Claims responsible for Claims. Your qualifications: Grade 12 (Essential)Relevant tertiary qualification; a medical degree in Nursing, Occupational Therapy, Physiotherapy is preferred Your Outputs (include but is not limited to):Evaluate claims forms and supporting documentation in preparation of making a payment decisionGathering information and various types of reports from medical practitionersCompare the reports to our existing claims criteria to establish if claim is payableDecide on levels of provisions to be raised based on information receivedWriting claims assessment in line with standards/policiesAuditing/QA of work done by peersDeliver claims decisions within the expected turnaround timeDetermine requirements / documents required to evaluate claimsLiaise with relevant re-insurers to determine validity of claims and get their approvals where requiredExplain and communicate final decisions to brokers and clientsCreate schedules for payments and obtain relevant approvalsCommunicate with relevant stakeholders throughout the claims processAssist other team members with complex mattersAdhoc project involvementPerform validation of policies in line with business and industry standard rules. Your experience:Minimum 3-5 years experience as a Claims assessor, preferably in a Senior positionExperience in both group and life individual life claims (Essential)Sound Business and Operational knowledge of Insurance Industry administrative processesGood knowledge of the business administration platformsFamiliar with Compliance Processes and Procedures in the Insurance Industry
16 Apr 2024;
from:
gumtree.co.za