Claims Assessor

4 weeks ago

Sandton City of Johannesburg Metropolitan Municipality Gauteng South Africa FreeRecruit Full time

Responsibilities and work outputs

Contribute to the ongoing enhancement and execution of the claims assessment methodology across Critical Illness, Income Protection and Lump Sum Disability benefit lines.
Approves or declines claim submissions without supervision within company guidelines.
Selects and accepts major risks on behalf of the company, evaluating proposals rather than mechanistic assessment.
Under general direction, assess complex cases that involve greatest risk.
Provide guidance and assistance to claims assessors and consultants.
Guide team members with risk assessment techniques, medical knowledge and best practice guidelines
Assist with the overall improvement of risk management within the living benefits assessment area.
Continuous development and application to ensure successful execution of the claims assessment methodology, including:
Current best industry and company practices
Claims research
Technological enablers
Embedding and applying established practices to ensure consistent application of these in the claims assessment environment.
To partner and collaborate with both internal and external stakeholders, not limited to product development, underwriting, CMO, reinsurance partners to improve claims assessment and client experience.
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 deliver.
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.
Risk opportunity identification to prevent fraud and to deliver quality work.
Assist with continuous improvement efforts by 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 drafting new policies and practices where necessary.
Ensure delivery of timeous and consistent claims assessments to Claim Consultants 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.
Build and maintain relationships with internal stakeholders responsible for the primary client.
Build and maintain relationships with internal stakeholders responsible for the primary client and advisor interactions (claims consultants).
Follow internal client service practices which build rewarding relationships and enables exceptional client service.
Contribute to a client service excellence culture which builds enduring relationships and allows team to provide exceptional client service.
Incorporate internal assessment feedback into the enhancement of daily business processes and management operating systems.
Act in a way that allows for a positive work climate and culture with fellow employees
Competencies

Business acumen
Client / Stakeholder commitment
Assertiveness
Drive for results
Collaboration and team work
Impact and influence
Results and solution focused
Self-awareness and insight
Diversity and inclusiveness
1-3 Experience in life insurance claims
Experience of general retail protection market product offerings beneficial
Relevant insurance knowledge, applicable regulatory requirements and legislations beneficial

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