Claims Assessor

4 weeks ago

Johannesburg, South Africa African Unity Life Ltd Full time

An authorised financial service provider, operating within the long-term insurance industry in South Africa, requires the services of a **Claims Assessor.** This is a 12-month fixed term contract.

**Tasks and responsibilities will include but not be limited to**:
**Key Responsibilities**:

- (The primary tasks, functions and deliverables of the role)_
- Assess claims in compliance with master policy guidelines:
Ensure a thorough assessment of claims to approval or repudiation stage in accordance with the established Claims Checklist and adhere to the rules of the master policy governing the specific scheme, policyholder, or claim event.
- Ensure timely allocation and action of claims:
Guarantee that all allocated claims are assessed and finalized on the workbench within the agreed Service Level Agreement (SLA).
- Effective communication with clients:
Communicate efficiently with clients during the assessment process, requesting additional information within the SLA to facilitate a smooth claims assessment process.

Ensure that clients are provided with real-time information on the status of their claims.
- Validate claims and documentation:
Assess the validity of claims and associated documentation. Promptly communicate any possible invalid claims.
- Assure Accurate and Correct Claim Capturing:
Ensure the accurate and correct capture of claims information, meeting all criteria necessary for claims payment.
- Assess Claims for Possible Fraud Risks:
Conduct assessments to identify and address possible fraud risks, maintaining the integrity of the claims evaluation process.
- Promote a culture of teamwork and meet daily deadlines:
Foster a collaborative environment by helping team members to collectively meet daily claims processing deadlines.

**Experience & Knowledge required**:

- At least 5 years’ experience in claims assessing
- Claims Administration within the Insurance Industry, with a requisite understanding of medical codes and terminology for accurate assessment of medical claims.
- Funeral, Credit Life insurance, Medical Insurance, Group Life Insurance
- Client Service experience
- TCF, POPI Act Knowledge
- FAIS Ombud Knowledge
- Policy Administration in the Insurance Industry would be advantageous.

**Skills and Abilities**:

- Microsoft office packages
- Analytical skills - Ability to assess and evaluate complex claim scenarios.
- Attention to detail
- Excellent communication skills
- Customer service orientated
- Good time management skills
- Problem solving skills
- Conflict resolution skills
- Adaptable
- Ethical, trustworthy with a high level of integrity.

**Qualifications**:

- Matric certificate / NQF level 4 qualification
- RE5 is preferred

**Remuneration: Market Related**

**Starting date**: As soon as possible

African Unity Life upholds a commitment to employment equity (EE), and appointments will align with the company's EE Plan.

**Job Type**: Temporary
Contract length: 12 months

Application Question(s):

- How many years experience do you have in assessing funeral insurance ?
- How many years experience do you have in assessing credit life insurance
- How many years experience do you have in assessing medical insurance
- How many years experience do you have in assessing group life insurance
- Do you have a RE5 qualification?

**Education**:

- High School (matric) (required)

**Experience**:

- Claims Administration within the Insurance Industry: 5 years (required)

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