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Life Claims Specialist
2 weeks ago
About Afrizan
Afrizan's core purpose is to provide innovative risk assurance to individual clients. We strive to enhance and protect lives by making people healthier.
We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Afrizan. Our fast-paced and dynamic environment enables smart, self-driven people to be their best.
As global thought leaders, Afrizan is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.
About the Job
This role involves ensuring that claims service strategy prevails in adherence to assessment of claims decisions being proved to stakeholders, in keeping with business rules, set criteria and service level agreement discipline.
Key Responsibilities
- Effective independent assessment of complex claims within high authority limit and skill level to ensure accuracy of decision-making identifying material non-disclosure, misrepresentation or fraud.
- Demonstrate proficient service through formal communication to ensure adherence to communication standards.
- Building relationships with brokers and franchises, engaging with top Premium platinum and Gold Prestige financial advisors to ensure successful execution of claims deliverables.
- Adherence to service level agreement discipline to ensure service standard.
- Attain a quality assurance of above 85% to ensure effective claims decision making and communication output.
- Coach and conduct training for junior or new assessing staff to ensure skills transfer and accurate decision making.
- Presents individual claims on disputes, declines, voids and reconstructs to various committees including medical, legal, underwriting, actuarial and compliance for verification.
- Analytical skills.
Required Qualifications and Experience
- Matric
- Diploma / Bachelor's degree in health-related field (such as nursing, occupational therapy, psychology, physiotherapy, etc.)
- 4-5 years of working experience in claims assessment of all types of benefits e.g. Life cover, disability, severe illness and income protection claims in the long-term insurance industry.
- Advantageous: 2-5 years underwriting experience in a long-term insurance industry.
- Risk management knowledge with experience of Individual Life claims assessment of all benefits.
- Medical knowledge in terms of terminology and interpretation of medical reports.
