Life Claims Assessor

2 weeks ago

Parktown North, Gauteng, South Africa Rand Mutual Assurance Full time

THE JOB AT A GLANCE
As a Life Claims Assessor, you will be reporting to the

Claims Manager:

Life, you will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.


WHAT WILL YOU DO?

Claims Adjudication:

  • Verify claims captured for correctness and compliance
  • Capture / accept additional information on claims i.e. medical reports
  • Ensure all documents required to process a claim are indexed and filed into the system
  • Add meaningful and accurate notes to ensure complete synopsis of claim on the system
  • Update requirements on claims and ensure they are always accurate and up to date

Claims Management:

  • Manage claims in line with individual targets
  • Review of claims in line with process, authority limits and within agreed timelines
  • Escalate where required within authority limits
  • Management of medical reports for claims with Permanent Disability
  • Communicate claims process to both the employer and employee as set out in the claim's management processes
  • Timeous management of workflows and notifications

Adjudicate and process payments for claims:

  • Adjudication and processing of TTD benefits including approval within authority limits
  • Adjudicating and processing payment of sundry invoices within authority limits
  • Process Permanent Disability claims

Customer Service:

  • Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
  • Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
  • Manage walkin queries as and when required in line with the RMA Service Catalogue
  • Research required information using available resources
  • Provide customers with accurate product and service information in an efficient manner
  • Update existing customer personal information on the system
  • Deal with all customers in a professional and empathetic manner

WHAT YOU'LL BRING TO THE TABLE?

  • Matric
  • FAIS Regulatory Examination (RE5)
  • NQF Level 5 Higher Certificate in a FAIS Recognised Qualification
  • A medical qualification would be advantageous
  • Insurance Qualification (advantageous)
  • 3 to 5 years claims related experience
  • General knowledge of the LTI Act
  • Intimate knowledge of the FAIS Act
  • Intimate knowledge of the GCOC
  • Intimate knowledge of the Insurance Act
  • General knowledge of the ASISA Standards and Guides
  • Good Administrative skills
  • Advanced Excel Skills
  • Knowledge of Claims processing, approval
  • Long Term Insurance experience
  • Deadline driven

WHAT WILL YOU GET IN RETURN?
We offer great opportunities for personal and professional development in a stable company that's 128 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

Turnaround time

Closing date: 27 July 2023

Our Commitment to transformation:

WHAT YOU'LL BRING TO THE TABLE?

  • Matric
  • FAIS Regulatory Examination (RE5)
  • NQF Level 5 Higher Certificate in a FAIS Recognised Qualification
  • A medical qualification would be advantageous
  • Insurance Qualification (advantageous)
  • 3 to 5 years claims related experience
  • General knowledge of the LTI Act
  • Intimate knowledge of the FAIS Act
  • Intimate knowledge of the GCOC
  • Intimate knowledge of the Insurance Act
  • General knowledge of the ASISA Standards and Guides
  • Good Administrative skills
  • Advanced Excel Skills
  • Knowledge of Claims processing, approval
  • Long Term Insurance experience
  • Deadline driven

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