Life Insurance Claims Assessor

2 weeks ago


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

JOB TITLE: Life Claims Assessor

Are 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 disease, and death.

Responsibilities:

  • Claims Evaluation:
  • Assess life insurance claims related to retrenchment, disability, dread disease, and death.
  • Review and verify policy terms, eligibility, and coverage.
  • Investigate and analyze the circumstances of each claim.
  • Ensure claims assessments align with market standards and company values.

Liaison with Third Parties:

  • Liaise with relevant third parties to assess disability, dread disease, and death claims.
  • Collaborate with healthcare professionals on medical claims.
  • Verify employment history for retrenchment claims.
  • Assess the impact of retrenchment on premium payments.

Documentation:

  • Maintain organized claim files with up-to-date documentation.
  • Prepare and submit necessary reports and recommendations.

Client Communication:

  • Interact professionally and empathetically with policyholders and beneficiaries.
  • Provide clear explanations and updates on claim status.

Adjudication:

  • Determine claim eligibility and benefits accurately.
  • Process claims benefits promptly.

Quality Assurance:

  • Enhance claim assessment processes for efficiency and accuracy.
  • Identify and escalate potential fraud cases.

Compliance:

  • Stay updated on industry regulations and company policies.
  • Process claims in compliance with legal and ethical standards.

Qualifications:

  • Degree in Insurance, Finance, or a related field.
  • RE5 & full FAIS qualifications beneficial.

Work Experience:

  • 3-5 years in life insurance claims assessment.
  • Comprehensive knowledge of South African insurance regulations.
  • Understanding of medical practices.

Personal Attributes:

  • Strong analytical and problem-solving skills.
  • Attention to detail and organizational skills.
  • Excellent communication abilities.


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