Claims Approver

5 months 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 Approver.** 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)_
- Approve claims in compliance with master policy guidelines: Ensure precise adherence to master policy rules governing specific schemes, policyholders, or claim events by the claims assessor.
- Ensure timely allocation and action of claims: Guarantee that reviewed claims are assigned by the correct assessor and acted upon within established service level agreements.
- Maintain accurate records of all claims: Execute precise filing for both approved and rejected claims, contributing to streamlined documentation.
- Verify claim payment details for accuracy: Prior to submission to the finance department, meticulously review and ensure the accuracy of all claim payment details.
- Efficiently handle disputes within defined timelines: Resolve disputes promptly, meeting required turnaround times and maintaining positive client relations.
- Address claim-related queries and assist in complaint resolution: Responsively assist with internal and external queries, collecting relevant information to efficiently address complaints and inquiries.
- Support Ombud complaints and investigations: Provide assistance in handling Ombud complaints, showcasing commitment to resolving external grievances.
- Generate and issue proof of payments and official correspondence: Prepare and distribute essential documents, including proof of payments, as well as letters notifying clients of payment or claim rejection.
- Assist clients with claims registers: Support clients by providing necessary information and assistance with claims registers upon request.
- Cultivate a risk-aware culture and report incidents: Actively promote a risk-aware culture, promptly logging any incidents on the risk register to ensure timely resolution.
- Identify and report fraudulent claims: Demonstrate caution in identifying potential fraudulent claims and promptly report findings to the Line Manager.
- 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 the claims assessing and 3 years’ experience in claims approval in life, funeral, medical, employee benefits and credit life insurance.
- Policy Administration in the Insurance Industry would be an advantage.
- Client Service experience
- TCF, POPI Act Knowledge
- FAIS Ombud Knowledge

**Skills and Abilities**:

- Excel, outlook, Microsoft PowerPoint
- 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 preferred

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

Application Question(s):

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

**Education**:

- High School (matric) (required)

**Experience**:

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

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