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Group Risk Claims Consultant
2 weeks ago
**EXPERIENCE IN THE FINANCIAL SERVICES/LIFE INSURANCE INDUSTRY ESSENTIAL**
Responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims.
Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and accurate decisions on claims worked on.
Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work.
Evaluate claims forms and supporting documentation in preparation of making a payment decision.
Gathering information and various types of reports from medical practitioners.
Compare the reports to existing claims criteria to establish if claim is payable.
Decide on levels of provisions to be raised based on information received.
Writing claims assessment standards/policies.
Auditing/QA of work done by peers.
Deliver claims payment decision.
Determine requirments/documents required to evaluate claims.
Liase with relevant re-insurers to determine validity of claims and get their approvals where required.
Explain and communicate final decisions to brokers and clients.
Create schedules for payments and obtain relevant approvals.
Relevant tertiary qualification: a medical degree as an Allied Health professional is preferable (Physio. OT, Nurse, Biokineticist)
Min 3-5 yrs’ experience as a Claims Assessor.
Exp in both group and life individual life claims is ess.
Business and operational knowledge of insurance Industry administrative processes.
Good knowledge of the business administration platforms.
Familiar with compliance processes and procedures in the insurance industry.
Familiar with the business products and their rules and workings.
Case management.
2.11kb
**Job Types**: Permanent, Full-time
Ability to commute/relocate:
- Sandton, Gauteng: Reliably commute or willing to relocate with an employer-provided relocation package (required)
**Education**:
- Bachelors (preferred)
