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Intermediate Sickness Claims Assessor
2 weeks ago
Job Advert Summary:
This role reports to the Team Manager Claims. Responsible for assessment and processing of short-term Sickness, Critical Illness and Hospital claims. The incumbent will deal with technical and complex claims queries and/or complaints providing an excellent service offering.
Minimum Requirements:
Education:
- Medical qualification compulsory (Nursing, Occupational Therapy and Physiotherapy or related)
Experience:
- 3 years' experience in the insurance industry
- 2 years' experience in claims assessment including Income protection, Lump Sum, Disability and dread disease
Knowledge and Skills (maximum of 10):
- Fluent in English both written and verbal
- Must have excellent telephone etiquette
Good computer knowledge
- MS Outlook, Excel and Word are necessary
- Good report writing and presentation skills
- Must have a mature, disciplined and driven personality
- Ability to work independently as well as being a good teamplayer with excellent interpersonal skills
- Attention to detail
- Deadline/target driven, with ability to work under pressure
- Logical and analytical
- Effective time management skills
Competencies:
- Communication skills (written and verbal)
- Business writing skills
- Planning and organizing
- Attention to detail
- Client centricity
- Building and maintaining relationships
- Resilience
Duties and Responsibilities:
Process optimization and efficiencies:
- Assessment and management of shortterm sickness, critical illness and hospital claims
- Review all medical information on file, analyze and synopsize information at hand.
- Determine and record additional required information.
- Decide on referral to an independent specialist.
- Receive Independent Specialist reports and analyze and synopsize the report in context of the claim and PPS Provider Policy.
- Correspondence to clients with respect to claims outcomes and requirements for future claims in order to manage claims.
- Keeping accurate records of all claims assessed in accordance with departmental procedures.
- Deal with Arbitration and Ombudsman cases and collaborate with other stakeholder during the Complaints process.
- Participation in projects to improve departmental serviceowning your role in the project and completing tasks as required by providing input.
Risk and Compliance:
- Adhere to internal SLA's to ensure operational efficiency and achievement of agreed customer service standards.
- Proficient in the assessment of claims.
- Must understand claims environment and general claims protocols and processes.
- Ensure adherence to audit requirements.
- Ensure adherence to regulatory and compliance requirements
People and Culture:
- Checking and Authorization of claims in terms of published delegation of authority.
- Collaboration with relevant stakeholders: Research & Development, Legal, Operational Accounts, Nondisclosure and Internal Control.
- Contribute and assist to review processes and protocols where required to assist in PPS' delivery of quality claims decisions.
- Forge strong working relationships with stakeholders
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