Claims Assessor

1 week ago

Sandton, South Africa Guardrisk Full time

**Introduction**
- Full responsibility for 3rd party claims, end-to-end assessing and decision making, reporting, analysis and feedback to Life Ops and Capitec Ops Executives. Full responsibility for other claims, end-to-end assessing and decision making.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**
- Full responsibility for 3rd party claims, end-to-end assessing and decision making, reporting, analysis and feedback to Life Ops and Capitec Ops Executives. Full responsibility for other claims, end-to-end assessing and decision making.

**Requirements**:

- Matric /Grade 12
- Relevant Insurance Experience
- Claims related experience advantageous
- Medical background advantagous
- Underwriting background advantageous
- At least 3- 5 years claims handling

**Duties & Responsibilities**
- Being responsible for 3rd party claims (Non-mandated intermediaries)
- Co-ordinates and performs the full assessment function in ensuring that all claims are dealt with swiftly
- Role serves as direct support for the life claims business unit
- All claims to be captured onto the Claims System
- Feedback to be provided to life claims team
- Feedback to be provided to relevant binder holders
- Monthly reporting to be provided
- Escalation of complex claims to the Claims Committee
- Handling of complaints
- Knowledge of the business practices and procedures of Claims.
- Knowledge of cell captive information so the claim is captured under the correct client details
- Being aware of whom to follow up with for speedy administration and query resolution
- Understanding of technical medical terminology
- The ability to access and integrate information quickly
- Application of Rule 17 of the PPR’s and the TCF Outcomes
- Application of sound claims processes and interpretation of policy wording
- Application of Rule 18 of the PPR’s
- Professional and efficient service level delivery
- Promote TCF / PPR outcomes
- Keeping abreast of developments within Guardrisk
- Handling of extraordinary cases/ situations
- Responsible for point of contact resolution process for the business and liaising with other business units where necessary to finalize capturing of customer requests/complaints
- Gathering of required information in order to finalise capturing requirements
- Assessing all 3rd party claims
- Assessing claims landing in the Life Claims inbox
- Performing analysis on data for trend identification and feedback
- Assistance with ad-hoc projects from time to time
- Assistance with filing and record-keeping
- Responding to complaints
- Performing Root Cause Analysis on complaints

**Competencies**
- Accountable for service delivery through own efforts
- Time-management
- Self-motivated
- Collaborative
- Accepts and lives the company values
- Disciplined
- Team player
- Computer literacy essential (Word/Excel/Outlook)
- Problem solving skills
- Organisation Skills
- Excellent communication (verbal & written) interactive skills
- Complaints Management

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