Life Claims Assessor 12 Months Contract

6 months ago


Parktown, South Africa Rand Mutual Assurance Full time

**Purpose**

To effectively and efficiently process and adjudicate Funeral Fund Claims, within the scope of the Funeral Fund policy rules and prevailing legislation. Also, to enhance and improve customer experience through effective assessment of claims and meeting the requirements and expectations of the role set out below.

**Qualifications and Experience required**

Grade 12
A National Diploma or Degree (minimum NQF level 5)
Computer literacy: Advanced MS Word, Excel and Outlook
Insurance Qualification (advantageous)
1-year industry experience (minimum)

Regulatory Exam

**Key Areas of responsibility**

Effectively and efficiently perform the function of a Funeral Claims Assessor:
Assess all funeral claims for validity and process for approval

Communicate outstanding requirements to brokers/clients on pending claims, according to the follow up process and procedures

Adhere to a 24-hour turnaround time for all funeral claims

Finalise each claim on system e.g. Correct claim status should reflect (Paid/Declined/Pending/Closed/Unclaimed)

Draft and forward payment and repudiation letters for all funeral claims on the same day in which the claim was finalised

Update notes with comments regarding the progress of the claim

Ensure that the assessment synopsis is correctly executed under notes on the system and that the assessing decision is done in the correct format as set out in the process and procedures documents

Assist with walk in clients when required

Deal with complaints received on claims from clients/brokers

Follow all referral criteria e.g. Forensics

Ensure all scanned documents have been indexed correctly

Management of notifications

Follow up on notifications where full claims have not yet been received

Management of the timeous finalization of claims

Adherence to company standard operating procedures

Ensure that the highest quality is maintained, and that the communication sent to clients/brokers is double checked for validity and accuracy

Deal with claims assessing escalations

Utilise validation tools as set out in the claims process e.g. XDS, VOPD etc.

**Adjudicate and process payments for claims**

Adjudication and processing of funeral and death benefits including approval within authority limits.

Adjudicating and processing payment of critical illness within authority limits.

Adjudicate Permanent Disability claims.

**Knowledge, Skills and Competencies required**

Knowledge of administrative and clerical procedures

Telephone skills - Advanced
System navigation skills - Intermediate
Customer interfacing skills (face to face/written/telephonic) - Advanced
Computer literate - MS Office - Intermediate
Numeracy
Knowledge of Customer Service principles and practices
Multilingual
Excellent Keyboard skills
Good Administrative skills
Good communication skills, verbal and written
Ability to work under pressure, be target driven and meet deadlines
Own Transport
Valid Driver’s License
Regulatory and Long Term Insurance Compliance procedural knowledge

Timeous handling of work assigned.
Availability of information to the manager for decision-making

Applied Learning
Building Customer Loyalty
Contributing to Team Success
Managing Work (includes Time Management)
Initiating Action
Stress Tolerance
Decision Making
Conflict Management skills
Adapting and responding to change
Following instructions and Procedures
Learning and researching
Relating and Networking
Achiever
Confidentiality
Credibility
Customer Service Orientated
Friendly
Objective
Integrity & Honest
Information and Information Management And Analysis Patient
Project wide perspective
Resilience
Resourceful
Self-motivated
Driven
Goal and target orientated


  • Life Claims Assessor

    4 weeks ago


    Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** As a Life Claims Assessor, you will be reporting to the Partner Claims Specialist - 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...

  • Life Claims Assessor

    2 months ago


    Parktown, 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?** **Effectively and efficiently perform the function of a Funeral...

  • Senior Claims Assessor

    2 months ago


    Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** As the Senior Claims Assessor, you will be reporting to the Team Leader: Senior Claims Assessor. 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?** **Adjudicate on claims**: - Adjudicate claims...

  • Senior Claims Assessor

    4 months ago


    Parktown, South Africa PPS Recruitment Full time

    **Job Advert Summary**: This role reports to the Team Manager Claims. Responsible for assessment and processing of short-term Sickness, Critical Illness and death claims. Quality assurance and authorization of claims for Junior and Intermediate claims assessors. Facilitate complex claims discussions within the team, conduct training and coaching to the team...

  • Claims Consultant

    2 months ago


    Parktown, South Africa PPS Recruitment Full time

    **Job Advert Summary**: Co-ordinate and oversee, manage negotiate and settle personal lines and commercial claims and account for the finalisation of the claim end-to-end. Delegate authority to manage the process and resolve any conflict by a negotiating, settlement, and finalisation functionality. Administer and validate claims correctly and efficiently...


  • Parktown, South Africa Rand Mutual Assurance Full time

    **Purpose** **Qualifications and Experience Required**: NQF Level 5 Higher Certificates and Advanced National (vocational) Certificate in business administration or commerce Additional insurance related qualifications or training will be advantageous. 2 - 3 years clerical, scanning and indexing experience required **Key Areas of...


  • Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** **WHAT WILL YOU DO?** **Claims Administration**: - Acknowledgement of claims upfront - Communicate and articulate the claims process and requirements to the claimants and brokers, as pre-defined processes - Refer/channel claims to relevant departments - Gather information, send follow-ups and reminders on outstanding claims...


  • Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** As the Pensions Medical Case Assessor (PMCA), you will be responsible for effectively and efficiently rendering medical support to internal and external stakeholders. **WHAT WILL YOU DO?** - Monitoring of Hospital Admissions weekly and liaison with Case Managers. - Give feedback to Case Managers and other Colleagues of Pensioners...

  • Human Resources Intern

    6 months ago


    Parktown, South Africa AJ Personnel Full time

    **Main purpose of the job**: - To provide administrative support to the Human Resources team and assist with a wide range of Human Resources related activities and tasks **Location**: - **Parktown - Johannesburg** **Key performance areas**: - Compile contract renewals, transfer/increase/promotion/retirement/change in working conditions letters,...

  • Motor Assessor

    6 months ago


    Parktown, South Africa Hollard Recruitment Full time

    **Job Advert Summary**: An exciting new **Motor Assessor **opportunity has just become available in our **Insure, Operations (Claims Area) Gauteng Branch.** *** **Role Objectives** To establish quantum of damaged vehicles for example fire damaged accident damaged and or stolen and recovered vehicles that have damages. Suggesting the final costing for...

  • Payments Administrator

    4 months ago


    Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** As a Payments Administrator, you will be responsible for assisting with the administration functions within the financial department for Claims, Commissions, Funeral and Pension payments. You will also be responsible for uploading payment reconciliations, reporting and actioning incoming queries. **WHAT WILL YOU DO?** **Payment...

  • Motor Assessor

    6 months ago


    Parktown, South Africa Hollard Recruitment Full time

    **Job Advert Summary**: Helloan exciting new opportunity has just become available in our Insure Operations, in the Motor Claims area. We are looking to recruit a Motor Assessor. Role Objectives: To establish quantum of damaged vehicles for example fire damaged accident damaged and or stolen and recovered vehicles that have damages. Suggesting the final...

  • Contracts Intern

    6 months ago


    Parktown, South Africa AJ Personnel Full time

    **Main purpose of the job**: - This position will suit a dynamic and self-motivated individual with excellent organizational skills, good writing skills, and good interpersonal communication skills - The main role is to be a liaison between WHC (legal and HR) and the SBIMB Projects Office **Location**: - **Sydney Brenner Institute for Molecular Bioscience...


  • Parktown, South Africa Hollard Recruitment Full time

    **Job Advert Summary**: Helloan exciting new opportunity has just become available in our **Insure, Operations Motor Claims area.** We are looking to recruit a **Final Costing Administrator.** **Role Objectives**: To manage and control the risks inherent within the motor assessing process and finalisation of final repair calculation to enable correct...

  • Project Coordinator

    6 months ago


    Parktown, South Africa AJ Personnel Full time

    **Main purpose of the job**: - Manage program activities and coordinate operations of the site, including key stakeholder engagement and financial oversight of funding **Location**: - **Parktown - Johannesburg** **Key performance areas**: - Development of implementation plans for the delivery of key project activities and outputs - Mobilizing partner...


  • Parktown, South Africa Hollard Recruitment Full time

    **Job Advert Summary**: Helloan exciting new opportunity has just become available in our **Insure Operations, in the Motor Claims area**. We are looking to recruit a **Motor Assessing Administrator.** **Role Objectives**: To provide administrative support to the Assessing team in a growing and demanding environment. Protect Hollard from being over exposed...


  • Parktown, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** Reporting to the Process and Systems Manager, the Process Analyst will be responsible for supporting RMA business units across the Group by mapping operational processes and documenting operating manuals for the execution of operational activities and duties, recommending areas for improvement in processes to reduce cycle times,...

  • Finance Intern

    6 months ago


    Parktown, South Africa AJ Personnel Full time

    **Main purpose of the job**: - To assist the Grants programmer officer with the management of the finances and procurement activities of the SBIMB projects according to good management practice, project protocols, and the standard operating procedures for the WHC and the NIH - To assist with the Wits accounts for the SBIMB **Location**: - **Sydney Brenner...

  • Technical Trainer

    6 months ago


    Parktown, South Africa AJ Personnel Full time

    **Main purpose of the job**: - Assist in ensuring that HIV viral load testing and EID program is aligned to national ART guidelines, thus ensuring a well-coordinated and functional HIV viral load and EID testing program **Location**: - **WDIH - Parktown, Johannesburg** **Key performance areas**: - Ensure facilities have all applicable handbooks, all...

  • Research Nurse

    2 weeks ago


    Parktown, South Africa AJ Personnel Full time

    Main purpose of the job: To provide clinical research assistance to the clinical trials team through patient enrollment, consent, data management/CRF file completion and basic nursing care Location: Parktown – Johannesburg Key performance areas: Receive patients referred by clinicians or clinical trial centre for screening Check patient files and...