Claims Assessor

7 months ago

Johannesburg, South Africa Sanlam Full time

MWL is dedicated to supporting, growing and empowering clients with affordable, simple, and suitable solutions, primarily through telephonic intermediary channels. We have approximately 100 tied sales agents, all dedicated to meeting the financial needs of our clients and prospective clients.

MiWayLife’s vision is to establish a world-class direct financial service business that seeks to:

- offer its clients excellent service, superior value products, and fair treatment always;
- be an employer of choice; and
- be a good corporate citizen and play a meaningful role in the transformation of the Financial Services industry.

MiWayLife’s culture is values-based and is built around the pillars of Accountability, Attitude, Energy Freedom and Professionalism. We are a family of vibrant and energetic free-thinkers, constantly looking to innovate and disrupt.

**What will you do?**
- This is a specialist position that reports directly to Operations Manager : Claims. The role is accountable for the execution of a compliant and effective claims administration function for both underwritten lives and simple funeral claims.- Key responsibilities include:
- Assess and execute Life and Funeral claims
- Undertake the full process of administrating a Life/Funeral claim from receipt to payment.
- Build relationships with external partners in getting claims information and expatiating claim settlements.

**What will make you successful in this role?**
- Analytical and detail minded
- Curious and investigating orientation
- Sound ethics
- Client orientated
- Financial acumen
- Problem solver
- Good communicator/confident
- Able to build relationships/partnerships
- Planning and organising orientation
- Quality orientation

**Qualification & experience**
- Grade 12 and a medical or nursing qualification
- Experience in financial distribution services, preferably reinsurance
- Minimum 2 years of experience in claims assessment
- Assessor certification will be advantageous.
- Medical background experience

**Knowledge and skills**

**IT**:

- MS: Office (Excel, Word, PP, Outlook)
- MIS
- CRM tools

**Business**:

- Financial services industry knowledge
- MiWayLife business and operating model
- Financial services product knowledge (MiWayLife)
- Relevant regulatory legislation and compliance knowledge
- Policy contracts governances, clauses, cover
- Claims and assessor principles, processes, and governances
- Underwriting processes and guiding principles (basic)
- Medical/health assessment indicators and metrics
- Call centre and sales processes
- Client complaints processes

**Qualification and Experience**
- Grade 12 with 3 to 4 years related experience.**Knowledge and Skills**
- Claims administration- Claims settlements- Claims approvals and rejections- Operate within claims guidelines and compliance**Personal Attributes**
- Self-development - Contributing independently- Decision quality - Contributing independently- Plans and aligns - Contributing independently- Manages conflict - Contributing independently**Build a successful career with us**
- We’re all about building strong, lasting relationships with our employees. We know that you have hopes for your future - your career, your personal development and of achieving great things. We pride ourselves in helping our employees to realize their worth.**Core Competencies**
- Cultivates innovation - Contributing independently- Customer focus - Contributing independently- Drives results - Contributing independently- Collaborates - Contributing independently- Being resilient - Contributing independently**Turnaround time**-
**Turnaround times**

The time taken to complete this process depends on how far you progress and the availability of managers.**Our commitment to transformation**
- MiWayLife is committed to transformation and embracing diversity and our employment equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

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