Claims Assessor
5 days ago
**Introduction**
- To process medical expense shortfall (gap cover) claims in accordance with stipulated service levels and the terms and conditions of cover as defined in the policy wording.
**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.
**Role Purpose**
- To process medical expense shortfall (gap cover) claims in accordance with stipulated service levels and the terms and conditions of cover as defined in the policy wording.
**Requirements**:
- Matric /Grade 12
- Basic medical qualification an advantage (e.g. nursing or similar qualification)
- Computer Literacy (MS Word, Outlook and Excel)
- FAIS Fit and Proper including RE5
- At least 2 years medical aid or gap cover claims processing and assessing experience
- At least 1 year insurance experience
- Basic knowledge of the local health and medical schemes industry, as well as an awareness of demarcation and legislation governing the local health industry
**Duties & Responsibilities**
- Receive new Seamless claims via Secured sites, importing them into the system - including the updating of members’ personal details - onto the claims administration system (OWLS) on the same day or within 24 hours of receipt
- Ensure claims data is successfully received from all contracted medical schemes in the correct electronic format and in accordance with agreed SLA’s
- Accurately capture the clinical details of a claim on the claims administration system (OWLS) on the same day or within 2 working days of receipt
- Prioritise claims where outstanding documentation has been received, ensuring these documents are captured within 48 hours of receipt
- Assess claims in accordance with practice guidelines, policy wording, and protocols
- Finalize and forward claims to the quality assurance team for approval or rejection
- Ensure prompt handling and feedback on claims
- Respond to capture queries within 48 hours of receipt
- Detect and act on potential fraudulent claims
- Maintain a high level of service when liaising with individual and corporate customers, intermediaries, binder holders, and colleagues
- Provide support to the front-line team for inbound call overflows, query handling, complaints handling, and mailbox coordination when requested
- Ensure the principles of Treating Customers Fairly (TCF) are delivered across all functions, with a specific focus on achieving TCF Outcome 6 (ensuring customers do not face unreasonable post-sale barriers to change product, switch provider, submit a claim, or make a complaint)
- Dealing with client and medical scheme queries as and when they arise within the stipulated timeframe.
**Competencies**
- Results and solutions driven.
- Strong focus on client centricity and service excellence.
- Strong problem-solving and decision-making capabilities.
- Organized and focused.
- Analytical skills with attention to detail.
- Resilient and able to work under pressure.
- Adaptable and self-disciplined.
- Good communication skills and the ability to professionally manage customers.
- Disciplined and reliable.
- A team player.
- Computer literate
- Willing to go beyond the normal working day to achieve target service levels
-
Claims Quality Assessor
5 days ago
Sandton, South Africa Guardrisk Full time**Introduction** - As a Claims Quality Assessor in our Admed department your role is to quality assess all claims processed by the Admed claims assessors checking for accuracy, completeness and validity. **Disclaimer** - As an applicant, please verify the legitimacy of this job advert on our company career page. **Role Purpose** - As a Claims Quality...
-
Disability Claims Assessor
5 days ago
Sandton, South Africa HR Genie Full timeSummary:The Disability Claims Assessor is responsible for accurately assessing, investigating, and managing long-term insurance claims, including disability and critical illness claims. This role requires strong analytical skills, attention to detail, and the ability to engage with various stakeholders to ensure fair and efficient claim outcomes. The ideal...
-
Claims Specialist Lead
2 days ago
Sandton, South Africa Guardrisk Full timeJob DescriptionTo effectively manage day-to-day and non-motor claims handling across various products, providing supervisory oversight over a defined area.Key ResponsibilitiesHandling / settling non-motor own damage claims in accordance with applicable policies and standard operating procedures.Ensuring timely resolution of claims within stipulated time...
-
claims handler
3 weeks ago
Sandton, South Africa HR Genie Full timeYour:Formal Education:MatricRelevant NQF 5Successfully completed the RE 5 Examination Level 1Experience:A minimum of three (3) years Claims experience with a claims settling mandateA minimum of five (5) years working experience within the Short Term Insurance industrywill enable you to do the following duties:Processes:Effectively maintain claims standards...
-
Claims Technician: Recoveries
3 weeks ago
Sandton, South Africa Guardrisk Full time**Introduction** - To manage a portfolio of liability claims and recoveries and to provide ad hoc technical advice to stakeholders.**Role Purpose** - To manage a portfolio of liability claims and recoveries and to provide ad hoc technical advice to stakeholders.**Requirements**: - Matric - 60 FAIS Credits - Computer literacy(MS Word, Outlook and Excel) - At...
-
Motor Claims Technician
6 days ago
Sandton, South Africa Guardrisk Full time**Introduction** To attend to day to day motor claims handling across various products and to provide supervisory oversight over a defined area. **Role Purpose** To attend to day to day motor claims handling across various products and to provide supervisory oversight over a defined area. **Requirements**: - Matric - Computer Literacy(MS Word, Outlook...
-
Claims Assessor
4 days ago
Sandton, South Africa Oneplan Underwriting Managers (Pty) Ltd. Full time**Main purpose of the job** Accurately assess claims. Provide support and education to clients and appropriate vendors/providers relating to claims queries, processes, and the policy. Project a professional company image through omni channel interaction. **Claims Assessing** - Timeous and accurate Assessing of claims (30 claims per day minimum). Queues...
-
Commercial Claims Handler Leader
2 days ago
Sandton, South Africa Guardrisk Full timeJob RequirementsWe seek an experienced professional to oversee the day-to-day and non-motor claims handling process for multiple products, focusing on supervisory responsibilities.Key AccountabilitiesLeading the settlement of non-motor own damage claims in accordance with company policies and procedures.Ensuring timely completion of claims within specified...
-
Insurance Claims Operations Supervisor
2 days ago
Sandton, South Africa Guardrisk Full timeRole PurposeThe successful candidate will be responsible for supervising the day-to-day and non-motor claims handling process for multiple products, with a focus on leadership and direction.Main ResponsibilitiesCoordinating the settlement of non-motor own damage claims according to company policies and procedures.Guaranteeing that claims are processed and...
-
Insurance Claims Administrator
3 days ago
Sandton, South Africa Core Group Southern Africa Full time**iStore** The home of everything Apple, iStore is Africa’s largest Apple Premium Reseller. With a retail footprint of more than 28 physical and online stores across Africa that provide Expert advice, Apple Authorised Repairs, Business, Education, training and technical support for anything and everything Apple. The Claims Administrators will be...
-
Desktop Assessor
3 days ago
Sandton, South Africa Discovery Ltd. Full time**Business Unit**:Discovery Insure **Function**:Forensics/Fraud/Fiduciary Services **Date**:7 Feb 2025 - Discovery - Insure - Desktop Claims Assessor Motor/Non-motor **About Discovery** - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and...
-
Motor Claims Technician
3 weeks ago
Sandton, South Africa Momentum Metropolitan Holdings Full timeIntroduction To attend to day to day motor and non-motor claims handling across various products and to provide supervisory oversight over a defined area. Role Purpose To attend to day to day motor and non-motor claims handling across various products and to provide supervisory oversight over a defined area and handling /settling motor own damage claims...
-
Nonmotor Claims Technician
3 weeks ago
Sandton, South Africa Momentum Metropolitan Holdings Full time-Introduction To attend to day to day and non-motor claims handling across various products and to provide supervisory oversight over a defined area. Role Purpose To attend to day to day and non-motor claims handling across various products and to provide supervisory oversight over a defined area. Requirements - Matric - Computer Literacy(MS Word, Outlook...
-
Group Risk Claims Consultant
2 weeks ago
Sandton, South Africa Moving Heads Personnel Full time**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...
-
Motor Liability Claims Technic
3 days ago
Sandton, South Africa Guardrisk Full time**Introduction** - To manage a portfolio of motor liability claims and to provide ad hoc technical advice to stakeholders.**Disclaimer** - As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose** - To manage a portfolio of motor liability claims and to provide ad hoc technical advice to...
-
Claims and Underwriting Administrator
2 weeks ago
Sandton, South Africa Discovery Ltd. Full time**Business Unit**:Discovery Employee Benefits**Function**:Claims Administration**Date**:4 Oct 2024 - Achieve more than** **YOU BELIEVE** - Discovery Corporate & Employee Benefits- Claims and Underwriting Administrator**About Discovery** - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in...
-
Non-Motor Claims Team Manager
2 days ago
Sandton, South Africa Guardrisk Full timeJob OverviewThis role involves overseeing the day-to-day and non-motor claims handling process for various products, focusing on supervisory responsibilities.Key TasksManaging the settlement of non-motor own damage claims according to policy guidelines and operational protocols.Ensuring claims are resolved within specified timeframes and Service Level...
-
Non Motor Claims Technician
3 weeks ago
Sandton, South Africa Guardrisk Full time**Introduction** To attend to day to day and non-motor claims handling across various products and to provide supervisory oversight over a defined area. **Role Purpose** To attend to day to day and non-motor claims handling across various products and to provide supervisory oversight over a defined area. **Requirements**: - Matric - Computer Literacy(MS...
-
Non-motor Claims Technician
3 weeks ago
Sandton, South Africa Guardrisk Full time**Introduction** - To attend to day to day and non-motor claims handling across various products and to provide supervisory oversight over a defined area.**Disclaimer** - As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose** - To attend to day to day and non-motor claims handling across various products...
-
Non-motor Liabilities Claims Technician
4 days ago
Sandton, South Africa Guardrisk Full time**Introduction** - To manage a portfolio of liability claims and recoveries and to provide ad hoc technical advice to stakeholders. **Disclaimer** - As an applicant, please verify the legitimacy of this job advert on our company career page. **Role Purpose** - To manage a portfolio of liability claims and recoveries and to provide ad hoc technical advice...