Claims Assessor Specialist

2 weeks ago


Pretoria, Gauteng, South Africa Discovery Limited Full time
Select how often (in days) to receive an alert:
Claims Assessor Specialist - Discovery Life Business Unit: Discovery Life

Function:
Claims Administration

Discovery – Discovery Life

Claims Assessor Specialist About Discovery Discovery's core purpose is to make people healthier and to enhance and protect their lives.

We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery.

Our fast-paced and dynamic environment enables smart, self-driven people to be their best.

As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Discovery Life Discovery Life is an ever growing fast-paced and dynamic environment that provides innovative risk assurance to individual clients.

This environment thrives on customer engagement and customer experience as well as mutually beneficial relationships with our brokers and other stakeholders.

It is important for our employees to provide a world class service to our internal and external clients, thereby ensuring long and sustainable relationships.

Key Purpose To ensure that the claims service strategy prevails in that adherence of the assessment of claims decisions are proved to the relevant stakeholders, in keeping with the business rules, set criteria and service level agreement discipline.

Areas of responsibility may include but not limited to Effective independent assessment of complex claims within high authority limit and skill level to ensure accuracy of decision-making identifying material non-disclosure, misrepresentation or fraud.

Demonstrate proficient service through formal communication to ensure adherence to communication standards.

Building relationships with brokers and franchises, engages with top Premium platinum and Gold Prestige financial advisors to ensure successful execution of claims deliverables.

Adherence to service level agreement discipline to ensure service standard. Attain a quality assurance of above 85% to ensure effective claims decision making and communication output. Coach and conduct training for junior or new assessing staff to ensure skills transfer and accurate decision making.

Presents individual claims on disputes, declines, voids and reconstructs to various committees including medical, legal, underwriting, actuarial and compliance for verification.

Analytical skills Qualification & Experience Matric Diploma/ Bachelor's degree in health-related field (such as nursing, occupational therapy, psychology, physiotherapy, etc. 4-5 years of working experience in claims assessment of all types of benefits e.g. Life cover, disability, severe illness and income protection claims in the long-term insurance industry.

Advantageous:

2-5 years underwriting experience in a long terms insurance industry Risk management knowledge with experience of Individual Life claims assessment of all benefits.

Medical knowledge in terms of terminology and interpretation of medical reports. EMPLOYMENT EQUITY

The Company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
#J-18808-Ljbffr

  • Pretoria, Gauteng, South Africa Finding Personnel (Pty) Ltd Full time

    JOB TITLE: Life Claims AssessorAre you ready to join our team as a Life Claims Assessor at our Insurance company in Waterkloof, Pretoria East? You will be reporting to the Claims Manager and playing a crucial role in ensuring that our policyholders receive accurate and efficient claim assessments and settlements related to retrenchment, disability, dread...

  • Claims Assessor

    2 weeks ago


    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    About Our Client: Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients. In line with their growth and commitment to excellence, they are seeking a dedicated and experienced Claims Assessor to...


  • Pretoria, Gauteng, South Africa Santam Full time

    OPPORTUNITYThis career opportunity is available for a Non-Motor region and the successful incumbent will be based in Centurion. WHAT WILL YOU DOReceiving instruction from Claims Service Consultant (appraisal notes & docs).Checking completion and correctness of document and policy conditions.Planning routes for claims, make arrangements and contact...

  • Claims Assessor

    2 weeks ago


    Pretoria, Gauteng, South Africa Medpharm Recruitment Full time

    The purpose of this position is to ensure that all claims are assessed using the appropriate rules and is paid correctly in line with the Scheme's benefit and tariff structures.Duties: Assessing and processing Medical Aid claims- Quality:Measuring of individual error rate to ensure no costs incurred due to assessing errors made.- Production:Process the...


  • Pretoria, Gauteng, South Africa Finding Personnel (Pty) Ltd Full time

    JOB TITLE:Junior Claims AdministratorAREA:Waterkloof, PretoriaINDUSTRY:Insurance Salary /CTC:R Report to:Claims Manager Job Summary: The Junior Claims Administrator is responsible for processing and managing claims, ensuring accuracy and compliance with company policies. This role involves understanding assessor and service provider reports, drafting...


  • Pretoria, Gauteng, South Africa Finding Personnel (Pty) Ltd Full time

    JOB TITLE: Junior Claims AdministratorAREA: Waterkloof, PretoriaINDUSTRY: InsuranceSalary / CTC: R 10 000Report to: Claims ManagerJob Summary:The Junior Claims Administrator is responsible for processing and managing claims, ensuring accuracy and compliance with company policies. This role involves understanding assessor and service provider reports,...

  • Claims Consultant

    2 weeks ago


    Pretoria, Gauteng, South Africa Multiform Human Development Full time

    Remuneration:to be discussed during the interview process and to be based on commission structure, according to a percentage split between the Consultant and the Company.Nature of employment: The successful incumbent will be employed on a permanent basis after completion of a probationary period.ExperienceFormal education and qualifications as a minimum...


  • Pretoria, Gauteng, South Africa Sydsen Full time

    Our client in the Insurance Sector is looking for aNon-Motor Short Term Insurance Assessor to join their team in Pretoria East.As a Non-Motor Claims Assessor you will be responsible for assessing, validating and finalising Non-Motor Claims.Responsibilities: Validate all incidents and claims Meeting with clients, witnesses, SAPS officials, etc. Finalise all...


  • Pretoria, Gauteng, South Africa PSG Konsult Full time

    Job description:The Claims Consultant will be responsible to provide administrative assistance and support in line with commercial lines insurance.Responsibilities: Client face to face meetings Liaising and providing feedback to clients of claim progress. Handling client queries Claims Management: the daily claims process from capturing received claims to...

  • Specialist, Claims

    2 weeks ago


    Pretoria, Gauteng, South Africa Standard Bank Of South Africa Limited Full time

    Business Segment: Insurance & Asset Management Location: ZA, GP, Roodepoort, Ellis Street 4 To ensure effective and efficient resolution of the Corporate and Commercial claims andrelated account payments by adhering to the identified processes, procedures,standards and exercising appropriate discretion and ensure delivery within the agreed SLAs and TATs of...


  • Pretoria, Gauteng, South Africa National Department of Public Works, Pretoria Full time

    Skills Development Quality Assurance Specialist (SETA) -Temporary Employment ( Six Months)A skills development quality assurance specialist is urgently required for a 6 months temporary contract, for a government agency based in Pretoria (Hatfield).Job purposeTo accredit and monitor skills development providers to provide training and promote skills...


  • Pretoria, Gauteng, South Africa Santam Full time

    OPPORTUNITYSantam's Tailored Claims Solutions department has positions available for a Claims Service Consultant: Desktop based in Centurion. WHAT WILL YOU DOThe purpose of this position is to determine the quantum and merit of segmented non motor claims by performing investigations, verifying the description of the event with the loss, negotiation (with...


  • Pretoria, Gauteng, South Africa 3SixtyHealth (Pty) Ltd Full time

    3Sixty Health has a great opportunity for a suitably qualified individual to fulfil the advertised position and join their team.3Sixty Health is a black owned and managed, reputable and a major player in driving South African economy by investing in ''black excellence''3SixtyHealth is 100% black owned and black managed administrator. It is accredited by the...


  • Pretoria, Gauteng, South Africa Motor Industry Bargaining Council Full time

    Duties and Responsibilities Coordinate the customer service team with the aim of resolving queries efficiently and effectively. Drive and motivate the customer service team to achieve targets and KPIs. Provide recommendations to enhance current customer service processes to improve efficiency and find new ways of delivering on the industry mandate. Coach...


  • Pretoria, Gauteng, South Africa Sanlam Full time

    About the Company- Santam is the market leader in the general insurance industry in Southern Africa. We are a large, diversified, expanding and transforming company and whilst based in South Africa, we are rapidly moving into a number of emerging markets, both in Africa and Asia.- Job Description- The purpose of this position is to determine the quantum and...


  • Pretoria, Gauteng, South Africa Discovery Limited Full time

    Select how often (in days) to receive an alert: Clinical Fraud Risk Specialist Business Unit: Discovery Health Function: Clinical Date: 27 May 2024 Discovery Health Clinical Fraud Risk Specialist Job level – Associate Specialist level About Discovery Discovery's core purpose is to make people healthier and to enhance and protect their lives. We seek...


  • Pretoria, Gauteng, South Africa Solver Full time

    PA Responsibilities.Financial Adjustments that need to be made - liaise with FC. i.e any expenditure made by trustees which need to be refunded.Invoices - loading of all monthly invoices, new creditors (request and follow up with bank confirmation letter)Send out notices for all meetings.Puts together a minute template with the agenda for PMMaintenance -...


  • Pretoria, Gauteng, South Africa JorDan Human Resources Full time

    Permanent JHB00716 IT Gauteng, Tshwane (Pretoria)SAP Warranty Specialist (Senior)Location: GautengContract Term: 1 April December 2025ESSENTIAL SKILLS REQUIREMENTS: Warranty Application Operations Support background Warranty Authorisations experience Extensive experience in Warranty Applications OperationsADVANTAGEOUS SKILLS REQUIREMENTS: SAP Sales and...


  • Pretoria, Gauteng, South Africa Sanlam Full time

    Who are we?MiWay is a direct financial services company.We are passionate about service excellence, convenience and offering our clients superior value products.Our Vision is to be a world-class direct financial services business that offers a complete array of services under one convenient umbrella – all managed are positive that with the right people on...


  • Pretoria, Gauteng, South Africa Sanlam Full time

    Who are we?MiWay is a direct financial services company.We are passionate about service excellence, convenience and offering our clients superior value products.Our Vision is to be a world-class direct financial services business that offers a complete array of services under one convenient umbrella – all managed online.We are positive that with the right...