Job Description

Job Summary

A reputable company requires a Claims Assessor:Life who will be based in Durban.

Claims Processing

• Confirm that the claim intimation is correct and valid.

• Check the status of the policy & receipt of premium (current and up to date), to facilitate claim processing.

• Responsible for ensuring that all the required supporting documentation is obtained to comprehensively assess the claim. If necessary, requesting the Claims Administrator to source outstanding documents.

• Responsible for evaluating and assessing the claim as per the policy wording/requirements documented in the policy wording.

• Responsible for updating inhouse systems with relevant information and developments throughout the assessment process.

• Responsible for making the xe2x80x9ccorrectxe2x80x9d decision in respect of the claim.

• Responsible to facilitate the process of claim settlement.

• Responsible for ensuring the accuracy and completeness of system data relating to the claim to facilitate the accuracy of system generated claim settlement amounts.

• Responsible for achieving daily performance targets.

• Responsible for calculating the correct claim amount payable

Administrative Duties

• Support all involved stakeholders with regard to claim queries.

• Ensure that all interactions and developments are well documented on inhouse systems.

• Ensure optimal use of MOS to manage workload.

• Responsible for generating payment requisitions to facilitate claim payments.

• Assume overall responsibility for the content of the decision notification sent out to all relevant parties.

Matric.

• Minimum Qualification: Relevant NQF 4

• Preferred Qualification: Further Education and Training Certificate (FETC) in Short Term Insurance, Long Term Insurance or Retail Insurance.

• FAIS Regulatory Exam for Representatives (RE5)

• A good understanding of general financial concepts is required.

• Approximately 4 to 5 years relevant work experience in a claims processing environment is required.

• Previous work experience in long term insurance services, financial services or an insurance company would be most valuable

*** Must have experience in assessing credit life products xe2x80x93 death, disability, dread disease and retrenchment***

MPC

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