Claims Assessor- Claims and Assessment Management Specialist
Melrose Arch, Johannesburg

• Responsible and accountable for disability and dread disease claims.
• Assess all claims consistently and decide on their validity.
• Provide clients with the necessary correspondence regarding the claim decision and review requirements
• Liaise with the relevant role players for claims needing active management
• Ensure claims are reviewed on time to ensure that any terminations are affected timeously
• Ensure that the review dates are set up and adhered to.
• Maintain the competence to ensure that disability claims issues are dealt with efficiently, service level agreements with internal and external clients are met and quality control is adhered to according to the audit requirements
• Keep relevant records and update existing systems and other spreadsheets to ensure that claims analysis can be performed
• Visit clients requesting direct contact and active management of claims
• Meet regularly as requested with brokers and their clients to discuss relevant claims issues and resolve any outstanding queries
• Ensure that good knowledge of the policies, terms and conditions and their application is maintained. Ensure claims standards are met relative to policy wording, market
• Assist in the development of processes to continually improve claims assessment standards
• Ensure that claims assessment and disability management practice is in line with the market.
• Handle client communication in a professional and diligent fashion.
• Ensure that all medical accounts are approved and forwarded for payment on receipt of the account and report
• Ensure that all “rehabilitation” and “return to work” cases are dealt with on time and followed up
• Communicate with the Consultant / broker / client regarding outstanding queries, either verbally or in writing, to obtain full and accurate information.
• Assist with processes not within portfolio, when required.
• Perform medical underwriting functions

Qualifications, Skills and Experience Required:

• Matric
• Post-Graduate medically aligned degree is preferable e.g. Occupational therapy
• Medical knowledge with 2-3 years clinical experience
• Min 1 year experience in Claims assessing experience in Group Risk in a Claims environment with exposure to Income Disability Claims (PHI), Capital Disability and Dread Disease claims.
• Insurance related studies especially the COP (Retirement Funds 1)/ Elements of Insurance is an advantage.
• Excellent computer knowledge and a good knowledge of Microsoft Office
• Excellent telephonic skills
• Excellent interpersonal skills
• Good written and verbal communication