Claims Assessor Specialist
1 month ago
**Business Unit**:Discovery Life**Function**:Claims Administration**Date**:3 Jun 2024- Discovery - Discovery Life
Claims Assessor Specialist
- **About Discovery**
- Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.
- **About Discovery Life**
- Discovery Life is an ever growing fast-paced and dynamic environment that provides innovative risk assurance to individual clients. This environment thrives on customer engagement and customer experience as well as mutually beneficial relationships with our brokers and other stakeholders. It is important for our employees to provide a world class service to our internal and external clients, thereby ensuring long and sustainable relationships.
- **Key Purpose**
- To ensure that the claims service strategy prevails in that adherence of the assessment of claims decisions are proved to the relevant stakeholders, in keeping with the business rules, set criteria and service level agreement discipline.
- **Areas of responsibility may include but not limited to**
- Effective independent assessment of complex claims within high authority limit and skill level to ensure accuracy of decision-making identifying material non-disclosure, misrepresentation or fraud.
- Demonstrate proficient service through formal communication to ensure adherence to communication standards. Building relationships with brokers and franchises, engages with top Premium platinum and Gold Prestige financial advisors to ensure successful execution of claims deliverables.
- Adherence to service level agreement discipline to ensure service standard.
- Attain a quality assurance of above 85% to ensure effective claims decision making and communication output.
- Coach and conduct training for junior or new assessing staff to ensure skills transfer and accurate decision making.
- Presents individual claims on disputes, declines, voids and reconstructs to various committees including medical, legal, underwriting, actuarial and compliance for verification.
**Competencies & Skills**
- Decision making skills
- Analytical skills
- Effective communication skills
- Attention to detail
**Qualification & Experience**
**Essential**:
- Matric
- Diploma/ Bachelor’s degree in health-related field (such as nursing, occupational therapy, psychology, physiotherapy, etc.
- 4-5 years of working experience in claims assessment of all types of benefits e.g. Life cover, disability, severe illness and income protection claims in the long-term insurance industry.
**Advantageous**:
- 2-5 years underwriting experience in a long terms insurance industry
- Risk management knowledge with experience of Individual Life claims assessment of all benefits.
- Medical knowledge in terms of terminology and interpretation of medical reports.
- EMPLOYMENT EQUITY
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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