Individual Life Claims Consultant - Sandton Verfied

R 24k per month Sandton, Gauteng Sandton, Gauteng more than 14 days ago 31-08-2021 8:59:05 AM
Individual Life Claims Consultant (2 positions)

Salary range: R20 000 – R26 000 per month
Plus 30% performance bonus of the basic salary

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 make appropriate and accurate decisions on claims worked on. Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work. Report to the Head of Claims.

• Evaluate claims forms and supporting documentation in preparation of making a payment decision
• Gathering information and various types of reports from medical practitioners
• Compare the reports to our existing claims criteria to establish if claim is payable
• Decide on levels of provisions to be raised based on information received
• Writing claims assessment standards/policies
• Auditing/QA of work done by peers
• Deliver claims payment decision
• Determine requirements / documents required to evaluate claims
• Liaise with relevant re-insurers to determine validity of claims and get their approvals where required
• Explain and communicate final decisions to brokers and clients
• Create schedules for payments and obtain relevant approvals

Grade 12 (Essential)
Relevant tertiary qualification; a medical degree preferable
MS Office and PC literate
Accurate typing skills
Minimum 2-3 years’ experience as a claims assessor
Experience in both group and life individual life claims (Essential)
Sound business and operational knowledge of Insurance Industry administrative processes

• Excellent verbal and written communication skills
• Quality driven
• Analytical mind and above average problem solving techniques
• Strong sense of ownership
• Pro-active and innovative k30.8b