Life Claims Assessor 12 Months Contract

**Purpose**

To effectively and efficiently process and adjudicate Funeral Fund Claims, within the scope of the Funeral Fund policy rules and prevailing legislation. Also, to enhance and improve customer experience through effective assessment of claims and meeting the requirements and expectations of the role set out below.

**Qualifications and Experience required**

Grade 12
A National Diploma or Degree (minimum NQF level 5)
Computer literacy: Advanced MS Word, Excel and Outlook
Insurance Qualification (advantageous)
1-year industry experience (minimum)

Regulatory Exam

**Key Areas of responsibility**

Effectively and efficiently perform the function of a Funeral Claims Assessor:
Assess all funeral claims for validity and process for approval

Communicate outstanding requirements to brokers/clients on pending claims, according to the follow up process and procedures

Adhere to a 24-hour turnaround time for all funeral claims

Finalise each claim on system e.g. Correct claim status should reflect (Paid/Declined/Pending/Closed/Unclaimed)

Draft and forward payment and repudiation letters for all funeral claims on the same day in which the claim was finalised

Update notes with comments regarding the progress of the claim

Ensure that the assessment synopsis is correctly executed under notes on the system and that the assessing decision is done in the correct format as set out in the process and procedures documents

Assist with walk in clients when required

Deal with complaints received on claims from clients/brokers

Follow all referral criteria e.g. Forensics

Ensure all scanned documents have been indexed correctly

Management of notifications

Follow up on notifications where full claims have not yet been received

Management of the timeous finalization of claims

Adherence to company standard operating procedures

Ensure that the highest quality is maintained, and that the communication sent to clients/brokers is double checked for validity and accuracy

Deal with claims assessing escalations

Utilise validation tools as set out in the claims process e.g. XDS, VOPD etc.

**Adjudicate and process payments for claims**

Adjudication and processing of funeral and death benefits including approval within authority limits.

Adjudicating and processing payment of critical illness within authority limits.

Adjudicate Permanent Disability claims.

**Knowledge, Skills and Competencies required**

Knowledge of administrative and clerical procedures

Telephone skills - Advanced
System navigation skills - Intermediate
Customer interfacing skills (face to face/written/telephonic) - Advanced
Computer literate - MS Office - Intermediate
Numeracy
Knowledge of Customer Service principles and practices
Multilingual
Excellent Keyboard skills
Good Administrative skills
Good communication skills, verbal and written
Ability to work under pressure, be target driven and meet deadlines
Own Transport
Valid Driver’s License
Regulatory and Long Term Insurance Compliance procedural knowledge

Timeous handling of work assigned.
Availability of information to the manager for decision-making

Applied Learning
Building Customer Loyalty
Contributing to Team Success
Managing Work (includes Time Management)
Initiating Action
Stress Tolerance
Decision Making
Conflict Management skills
Adapting and responding to change
Following instructions and Procedures
Learning and researching
Relating and Networking
Achiever
Confidentiality
Credibility
Customer Service Orientated
Friendly
Objective
Integrity & Honest
Information and Information Management And Analysis Patient
Project wide perspective
Resilience
Resourceful
Self-motivated
Driven
Goal and target orientated