Claims Consultant

6 months ago

Johannesburg, South Africa Wellwishers Full time

**Purpose of this role**:
The purpose of this role is responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and accurate decisions on claims worked on. Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work.

**Reporting Line**:
You’ll be based at our client's head office in Sandton, Johannesburg.

You’ll report to the Team Leader: Claims Assessing responsible for Claims.

**Required Qualifications**:

- Grade 12 (Essential)
- Relevant tertiary qualification; a medical degree preferable

**Responsibilities (include but is not limited to)**:

- Evaluate claims forms and supporting documentation in preparation of making an payment decision
- Gathering information and various types of reports from medical practitioners
- Compare the reorts to our exisitng claims criteria to establish if claim is payable
- Decide on levels of provisions to be raised based on information received
- Writing claims assessment standards/policies
- Auditing/QA of work done by peers
- Deliver claims payment decision
- Determine requirments / documents required to evaluate claims
- Liase with relevant re-insurers to determine validity of claims and get their approvals where required
- Explain and communicate final decisions to brokers and clients
- Create schedules for payments and obtain relevant approvals

**Required experience**:

- Minimum 2-3 years experience in Life Insurance Assessing
- Medical Background
- Experience in both group and life individual life claims (Essential)
- Sound Business and Operational knowledge of Insurance Industry administrative processes
- Good knowledge of the business administration platforms
- Familiar with Compliance Processes and Procedures in the Insurance Industry
- Familiar with the business products and their rules and workings
- Familiar with the business products and their rules and workings Your skills and character traits:

- MS Office and PC literate
- Accurate Typing Skills
- Excellent verbal and written communication skills
- Quality driven and strong Ability to pay attention to detail as accuracy is important
- Using effective interpersonal skills to resolve conflict situations
- Ability to work effectively with others and contribute to team task accomplishment
- Ability to multi-task and manage multiple priorities
- Have the ability to operate effectively under pressure
- Task and deadline orientated
- Analytical mind and above average problem solving techniques
- Strong sense of ownership
- Pro-active and innovative

**Salary**: R27,000.00 - R30,000.00 per month

Ability to commute/relocate:

- Johannesburg, Gauteng: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

- Do you have 3 or more years of experience in Insurance Claims Consulting?

**Education**:

- Diploma (required)

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