Claims and Underwriting Administrator

**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 exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.**About Discovery Corporate & Employee Benefits**
- Discovery Corporate and Employee Benefits is the first and only employee benefits provider to shape employee behaviour, creating healthier and wealthier workforces. It is an exciting business to be in as we reimagine the way retirement savings and life insurance are brought to companies and employees.**Key Purpose**
- Assisting the underwriters with general administration related to underwriting. Ensure brokers are well informed by providing accurate information to them in order to adequately support clients. Compile underwriting status reports. Provide or receive half cost medicals from other insurers. Ensure claim assessments and payment of lump sum benefits (Funeral, death, SIB and ICB) payments. Ensure that all disability claims are processed timeously.**Areas of responsibility may include but not limited to**
- Compile a report for brokers from SFE and Compass, send medicals requirements requests to brokers/SC in order to be completed by member for underwriting members’ over the acceptable limit.
- Link the received completed medicals to the system and allocate to the underwriters for a decision.
- Send completed medicals to another insurer on request and/or request completed medicals from other insurer to underwrite member.
- Load members on the system to the smart service team for a nurse to complete required medical documents.
- Access completed medicals from the Smart Service System if not already on SFE.
- Link the received completed medicals to the system and allocate to the underwriters for a decision.
- Verify the membership on Paradigm, that covers are aligned on SFE and Compass. Ensure member is on SFE.
- Ensure all documents submitted are correct and completed in full. Where documents are missing, source the documents from Meditech or other Pathologists.
- Once all documentation is attached on SFE, complete audit for Member and move it to the Underwriters.
- Investigate reasons for anomalies on any underwriting admin process and troubleshoot. Look out for members that need decisions to be re-applied.
- Receive claims from Indexing department for assessment of the funeral and death claims - member; child or spouse claims as well as extended family members. Assess each claim by verifying claim details against standard claims requirements. Liaise with Broker should documentation not be in order. Should discrepancies be picked up, refer the documentation to the Forensics Department and ensure regular follow-up until Forensics provide an investigation outcome.
- Once all documentation has been received, set up payment on the system for verification by second Assessor and Authoriser. Receive claims for verification (second assessing) and authorizing.
- Issue payment letters and/or claims decision letters to Brokers once payment has been approved
- Process disability claims (CD, ICB and SIB claims), acknowledge receipt and process accordingly
- Correspond with the brokers and members when we receive queries relating to their claims
- Ensure that claims are allocated to the assessor for further assessments
- Lead the process in ensuring that reminders, close case and suspensions are communicated efficiently and timeously.
- Personal Attributes- Self-starter with a high attention to detail and be able to multi-task
- Good at follow through
- Exceptional ability to communicate written and orally
- Problem solving and solution focused
- Analytical - interpretation
- Building relationships
- Coping with pressure (deadlines)
- Time-Management and Organizational Skills
- Must be team orientated, willing to assist other team members in the office
- Compassion: will be working with people who are sometimes in dire situations or going through difficult transitions. Must be compassionate to their situation and working with them in a positive way
- Outstanding customer service skills

**Education and Experience**
- Matric - essential
- Advanced Microsoft Excel proficiency
- Minimum 1 - 2 year’s working in Employee Benefits
- Group Risk claims experience
- Knowledge of Group Risk industry benefit usage and payments

**Employment Equity**
- The Company’s approved Employment Equity Plan and Targets will be considered a