| Date | 2024-07-07 |
|---|---|
| Job Title | Claims Assessor: Life (Kzn) |
| Employer | Datafin More Information |
| Salary | 0 |
| Category | It Computer |
| Location |
Kwazulu Natal / Durban |
Job Summary
Durban – KwaZulu Natal
- Confirm that the claim intimation is correct and valid.
- Check the status of the policy and receipt of premium (current and up to date), to facilitate claim processing.
- Responsible for ensuring that all the required supporting documentation is obtained to comprehensively assess the claim. If necessary, requesting the Claims Administrator to source outstanding documents.
- Responsible for evaluating and assessing the claim as per the policy wording/requirements documented in the policy wording.
- Responsible for updating in-house systems with relevant information and developments throughout the assessment process.
- Responsible for making the correct decision in respect of the claim.
- Responsible to facilitate the process of claim settlement.
- Responsible for ensuring the accuracy and completeness of system data relating to the claim to facilitate the accuracy of system generated claim settlement amounts.
- Responsible for achieving daily performance targets.
- Responsible for calculating the correct claim amount payable.
- Support all involved stakeholders with regard to claim queries.
- Ensure that all interactions and developments are well documented on in-house systems.
- Ensure optimal use of MOS to manage workload.
- Responsible for generating payment requisitions to facilitate claim payments.
- Assume overall responsibility for the content of the decision notification sent out to all relevant parties.
- Work on the queries on the Assessor 1 queue.
- Attend to ad hoc business partner queries.
- Attend to complaints received from the Complaints Department and walk-in clients.
- Work through negative deferred days and possible prescription.
- Work outbound call on vehicle claims in excess of 100 days old (will be allocated by Manager).
- Attend to email correspondence received from clients, business partners and internal.
- Ad hoc related administration related to claims.
- Ensure that the principles of TCF are embodied in the assessment process/decision.
- Provide excellent service to policy holders and business partners in respect of Claims.
- Responsible for providing supportive input to Customer Experience with regard to customer complaints.
- Liaise with policy holders regarding the status of their claim and keep them informed if necessary.
- Responsible for maintaining the service level standards agreed with business partners as per the SLAs.
- Matric / Grade 12.
- Minimum qualification: Relevant NQF 4.
- A medical qualification would be an advantage.
- Preferred qualification: Further Education and Training Certificate (FETC) in Short Term Insurance,
- Long Term Insurance or Retail Insurance.
- FAIS Regulatory Exam for Representatives (RE5).
- At least 2 – 4 years work experience as a Life Assessor is required.
- Previous work experience in long term insurance services, financial services or an insurance company would be most valuable.
- Relevant technical knowledge to understand the technical requirements of life assessment is required.
- A good understanding of general financial concepts is required.
- Good understanding of the claims assessment process.
- Detailed knowledge relating to the specialist/technical nature of life claims assessment.
- Good understanding of medical conditions and the ability to understand medical terminology and medical reports.
- Logical and analytical and able to make accurate, complete deductions from multiple sources of information received in respect of the claim.
- Knowledge of the relevant policies and the ability to understand and interpret relevant policy wordings.
- Able to make correct and timely decisions as informed by policy wordings.
- MS Office Skills including Excel.
- Ability to apply judgement and tact when providing explanations.
- Able to manage policy holder expectations.
- Ability to interpret medical reports.
- Good communication skills, both written and verbal.
- High levels of attention to detail to ensure accuracy and completeness.
- Ability to work independently and demonstrate initiative.
- Team orientation. Committed to team goals, targets and objectives.
- Good organisational and time management skills. Able to plan and prioritise in order to meet deadlines.
- Results focused.
- Quality orientation.
- Customer Service orientation.
- Integrity.
- Empathetic, patient and tolerant.
- Diplomatic and mindful of impact.
- Cross cultural awareness.
- Assertive and confident.
Claims Assessor: Life (Kzn) position available in Kwazulu-Natal, Durban. This job position was posted by Datafin. The job has been posted as a premium ad on 2024-07-07 at 16:00:38 in the It Computer category
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