Death Claims Assessor MMH251119-8

Role Purpose To provide specialist and accurate death benefit claim decisions, through assessing client’s information as well as medical information aligned to the product and policy agreement. Requirements Matric / Grade 12 Relevant business‑related qualification. Relevant Insurance/Financial services Industry, applicable regulatory requirements and legislations knowledge and experience. Minimum of 5 years’ experience in life insurance claims (preferred). Knowledge of medical terminology (preferred). Duties and Responsibilities Assist with development and execution of an industry renowned claims assessment methodology across the Death benefit portfolio through continuous development based on current best industry and company practices and technological enablers. Ensure that assessment methodology and execution is in line with legislation and best practices within the financial management field in order to optimise the claims assessment service offering and delivery. Familiar with the regulatory framework, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled. Complete quality industry assessments within the required service levels aligned to product and policy requirements. Partner and collaborate with both internal and external stakeholders, not limited to product development, underwriting, medical officer, reinsurance partners to improve claims assessment and client experience. Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement. Embed and apply tools that allow for more efficient decision making, processing and risk management capabilities. Providing insight, knowledge, assistance and provide testing support where necessary as part of the development and maintenance of all claims systems to improve quality and efficiency. Assist with the review of all claims policies, practices, forms and documentation to ensure that our risk management standards are met and aligned to relevant product changes and legislative updates. Ensure delivery of timeous and consistent claims assessment feedback to clients by managing and maintaining workflow and service level standards. Assist with the delivery of accurate and timeous reporting, analysis and insights where required, and implementation of findings into the execution of claims assessment to improve the client experience and risk management. Incorporate internal assessment feedback into the enhancement of daily business processes and management operating systems. Provide factual, logical, expertise and advice to clients and stakeholders. Build and maintain relationships with clients, internal and external stakeholders. Deliver on service level agreements with all stakeholders to ensure that client expectations are met and managed. Make recommendations to improve client experience and fair treatment of clients within area of responsibility. Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service. Ensure compliance to regulatory Treating Customer Fairly outcomes. Develop and maintain productive and collaborative working relationships with peers, team members and stakeholders. Positively influence and participate in change initiatives. Continuously develop own expertise in terms of professional, industry and legislation knowledge. Contribute to continuous innovation through the development, sharing and implementation of new ideas. Take ownership for driving career development. Responsible to manage, identify and mitigate risk through the adherence of the claims process. Identify to enhance cost effectiveness and increase operational efficiency. Manage financial and other company resources under your control with due respect. Provide input into the risk identification processes and communicate recommendations in the appropriate forum. As an applicant, please verify the legitimacy of this job advert on our company career page.- #J-18808-Ljbffr