Claims Assessor I
1 week ago
About us, purpose, experience and qualifications
**about us**:
**purpose**:
Accurate assessment, investigation and validation of long-term insurance claims in accordance with the goals, objectives, processes and standards of the organization in order to meet customer. These claims may include funeral, death, disability, dread disease and retrenchment claims.
**experience and qualifications**:
- Grade 12.
- Suitable tertiary qualification.
- At least 5 years experience in risk claims which must include experience in funeral, death, disability, dread disease and retrenchment claims on simple and complex life insurance products.
- Experience in identification of managing claims fraud.
- Long-term insurance industry and product knowledge.
- **additional requirements**:
At least 3 years of experience in assessing living benefits, this includes Health cash (hospitalization), disability and critical illness benefits. Preferred qualification is a Registered nurse (or similar) with an understanding of long-term insurance. Experience in dealing with escalations /Ombudsman complaints
**responsibilities**:
- Analyse, provide assistance and guidance to team leaders and assessors with the technical aspects of claims.
- Ensuring adherence to organisational best practice and legislative requirements.
- Accurate assessment, investigation and validation of complex long-term insurance claims/ claims with high value in accordance with the goals, objectives, processes and standards of the organization in order to meet customer. These claims may include funeral, death, disability, dread disease and retrenchment claims.
- Taking ownership of queries and ensuring they are resolved timeously and effectively
- Ensuring all risks are mitigated and escalated, this includes the identification of fraudulent activity and non disclosure.
- Continuously assess own performance, seek timely and clear feedback and request training where appropriate.
- Providing effective, efficient and professional service to all our customers and branches, both telephonically and through written correspondence.
- Assist with system and process development.
- Teamwork to meet service and quality standards.
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