Claims Assessor

4 weeks ago

Durban, South Africa Rand Mutual Assurance Full time

**THE JOB AT A GLANCE**

As the Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.

**WHAT WILL YOU DO?**

**Claims Adjudication**:

- Verify claims captured for correctness and compliance
- Capture / accept additional information on claims i.e. medical reports
- Ensure all documents required to process a claim are indexed and filed into the system
- Add meaningful and accurate notes to ensure complete synopsis of claim on the system
- Update requirements on claims and ensure they are always accurate and up to date.

**Claims Management**:

- Manage claims in line with individual targets
- Review of claims in line with process, authority limits and within agreed timelines
- Escalate where required within authority limits
- Management of medical reports for claims with Permanent Disability
- Communicate claims process to both the employer and employee as set out in the claim’s management processes
- Timeous management of workflows and notifications.

**Adjudicate and process payments for claims**:

- Adjudication and processing of TTD benefits including approval within authority limits
- Adjudicating and processing payment of sundry invoices within authority limits
- Process Permanent Disability claims.

**Customer Service**:

- Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
- Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
- Manage walk-in queries as and when required in line with the RMA Service Catalogue
- Research required information using available resources
- Provide customers with accurate product and service information in an efficient manner
- Update existing customer personal information on the system
- Deal with all customers in a professional and empathetic manner.

**WHAT YOU'LL BRING TO THE TABLE?**
- FAIS Regulatory Examination (RE5)
- NQF Level 5 Higher Certificate in a FAIS Recognised Qualification
- A medical qualification would be advantageous
- 3 to 5 years claims related experience
- Intimate knowledge of the COID Act
- Good Administrative skills
- Advanced Excel Skills
- Knowledge of Claims processing, approval
- Insurance and/or Medical Aid experience
- Deadline driven

**WHAT WILL YOU GET IN RETURN?**

We offer great opportunities for personal and professional development in a stable company that’s 128 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

**Turnaround time**

**Closing date: 18 May 2023**

**Our Commitment to transformation**:

- FAIS Regulatory Examination (RE5)
- NQF Level 5 Higher Certificate in a FAIS Recognised Qualification
- A medical qualification would be advantageous
- 3 to 5 years claims related experience
- Intimate knowledge of the COID Act
- Good Administrative skills
- Advanced Excel Skills
- Knowledge of Claims processing, approval
- Insurance and/or Medical Aid experience
- Deadline driven

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