Claims Auditor

14 hours ago

Centurion, South Africa Kamo Placements Full time

**JOB DESCRIPTION**
- Audit Planning audit scoping, sample preparation on working papers and conducting opening meetings, audit planning memorandum
- Implementation testing scoped work and challenge control design and effectiveness, keep evidence and manage time accordingly
- Technical assessment of claim by checking the applicable cover, scheme and member details, eligibility, financial details
- Assess and confirm the eligibility, authenticity and validity of all evidence submitted by clients
- Acknowledge all information received and let the client know who the assessor is
- Claims assessing and validation including settlement, rejection and repair within set SLA
- Loss adjustment by correctly quantifying losses
- Provides input into the development or changing of operations policies or drafting of new policies and/or claims control systems on request.
- Consults existing control systems to determine components that can be utilised/amended in the required control system.

**JOB REQUIREMENTS**
**Preferred Minimum Education and Experience**
- Commercial Degree (BCom/ Business Management/ Economics/ Law/ Risk Management)
- 3-5 years experience in short term and/or Life insurance claims negotiation and handling
- 3-5 years experience in short term and/or Life general insurance
- 3-5 years experience in claims handling and Auditing
- 3-5 years claims auditing experience of SLA partners, UMAs and Binder Holders

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