Claims Pre-Assessment Consultant
3 weeks ago
Purpose of the Job: The Consultant: Pre-Assessment is responsible for the pre-assessment of prospective claims applications.
Key Performance Areas:
Pre-Assessment of Prospective Claims:
- Record all submitted documents for prospective claims.
- Determine benefits and products submitted based on submitted documents.
- Assess submitted documents to determine compliance as per defined processes and rules.
- Apply compliance and lodgment rules in pre-accessing the prospective claim.
- Identify duplicate claims and linked claims.
- Examine prescription of lodgment and apply prescription rules.
- Verify mortality with Home Affairs.
- Communicate assessment outcomes to prospective claimants.
Quality Assurance:
- Ensure pre-assessment processes are implemented and maintained at the highest standards.
- Maintain implementation of unusual occurrence procedures.
Administrative Support:
- Document acknowledged claims.
- Deal with and respond to correspondence.
- Produce documents, briefing papers, reports, and presentations.
- Assist with typing and editing briefs, technical papers, letters to various parties, and memos.
Reporting:
- Track and report against set objectives and targets.
- Report on emerging risks.
- Provide ad hoc reports on process improvement initiatives.
Stakeholder Management:
- Maintain healthy relationships with all stakeholders.
- Follow up and feedback to all stakeholders to keep them updated on the status of a query.
- Respond to queries within predefined turnaround times.
Qualifications:
- Bachelor's Degree/Advanced Diploma in a related qualification.
Experience:
- Relevant 3 years' experience in the claims environment.
Technical and Behavioral Competencies Required:
- Ability to differentiate different RAF Products.
- Knowledge of Motor Vehicle Act.
- Complex problem identification, solving, and decision making.
- Customer value proposition.
- Good financial management skills.
- Strong analytical capabilities.
- Knowledge of Motor Vehicle Accident legislation.
- PFMA knowledge.
- Attention to detail.
- Planning, Organizing, and Coordinating.
- Personal Mastery.
- Judgement and Decision Making.
- Ethics and Values.
- Client Service Orientation.
RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs.
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