Claims Assessor

3 weeks ago

Cape Town, South Africa Kontak Recruitment SA Full time

Cape Town, Western Cape - Administrative

**Claims Assessor (JB4315)**
**Claremont, Cape Town, Western Cape**
**R16 000 - R19 000 CTC per month based on experience**
**Permanent**

A leading provider of insurance solutions, dedicated to delivering exceptional service and peace of mind to their clients and strives to exceed expectations by consistently upholding the highest standards in the industry is looking for a claims assessor to join their team.
As a Claims Assessor, you will play a crucial role in ensuring the efficient and accurate processing of insurance claims as well as the validity of the claims. Additionally, you will be responsible for communicating effectively with clients and brokers to address claim expectations and manage inquiries.
**Minimum Requirements**:
Medical Aid claims processing experience
Administration experience
Insurance industry experience
Excel proficient
MS Office proficient
**Duties**:
Review and authenticate all incoming GAP claim documents, and proactively request any missing documentation.
Adhere to established procedures for processing claims, meticulously recording all pertinent information into our system.
Validate and amend client personal data changes within the policy records on the system.
Evaluate claim legitimacy according to the terms and conditions outlined in the client's policy documentation, and meticulously document findings.
Ensure client satisfaction by effectively addressing and managing claim expectations, employing Treating Customers Fairly (TCF) principles, and maintaining clear communication with clients or brokers.
Achieve daily minimum claim targets with precision and within specified service timeframes.
Organize and update daily workflow tasks and queues to ensure timely processing.
Prioritize and expedite high-priority and escalated claims, ensuring resolution within a strict two-hour timeframe as directed by management.
Collaborate with medical aids, hospitals, and medical practitioners to gather relevant medical history and account details crucial for claim assessment.
Perform various administrative duties as needed to support departmental operations.
IMPORTANT: We specialize in specific niche fields. Regret that we are unable to provide assistance for any fields outside of this scope. Fields can be viewed on our website.
Kontak Recruitment Disclaimer:
Equal opportunity: All backgrounds are welcomed, with no bias. All are considered based on requirements.
Job specifics: Requirements mirror advertisement, duties may adjust for client needs.

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Offer clarity: Advert is not a binding offer. Written offers based on pre-employment conditions.
No direct link: Advert is not tied to Kontak Recruitment. We assist in the employment process ONLY.
Applicant Responsibility: Upon applying, confirmation of receipt for a specific advert is given. If no confirmation is received, you must verify with Kontak Recruitment.

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