Job Description

Full responsibility for 3rd party claims, end-to-end assessing and decision making, reporting, analysis and feedback to Life Ops and Capitec Ops Executives. Full responsibility for other claims, end-to-end assessing and decision making.
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Role Purpose
Full responsibility for 3rd party claims, end-to-end assessing and decision making, reporting, analysis and feedback to Life Ops and Capitec Ops Executives. Full responsibility for other claims, end-to-end assessing and decision making.
Requirements

• Matric /Grade 12
• Relevant Insurance Experience
• Claims related experience advantageous
• Medical background advantagous
• Underwriting background advantageous
• At least 3- 5 years claims handling

• Being responsible for 3rd party claims (Non-mandated intermediaries)
• Co-ordinates and performs the full assessment function in ensuring that all claims are dealt with swiftly
• Role serves as direct support for the life claims business unit
• Ensuring all emails are dealt with within 24 hours
• All claims to be captured onto the Claims System
• Feedback to be provided to life claims team
• Feedback to be provided to relevant binder holders
• Monthly reporting to be provided
• Escalation of complex claims to the Claims Committee
• Handling of complaints
• Knowledge of the business practices and procedures of Claims.
• Knowledge of cell captive information so the claim is captured under the correct client details
• Being aware of whom to follow up with for speedy administration and query resolution
• Understanding of technical medical terminology
• The ability to access and integrate information quickly
• Application of Rule 17 of the PPR's and the TCF Outcomes
• Application of sound claims processes and interpretation of policy wording
• Application of Rule 18 of the PPR's
• Professional and efficient service level delivery
• Promote TCF / PPR outcomes
• Keeping abreast of developments within Guardrisk
• Handling of extraordinary cases/ situations
• Responsible for point of contact resolution process for the business and liaising with other business units where necessary to finalize capturing of customer requests/complaints
• Gathering of required information in order to finalise capturing requirements
• Assessing all 3rd party claims
• Assessing claims landing in the Life Claims inbox
• Performing analysis on data for trend identification and feedback
• Assistance with ad-hoc projects from time to time
• Assistance with filing and record-keeping
• Responding to complaints
• Performing Root Cause Analysis on complaints

• Accountable for service delivery through own efforts
• Time-management
• Self-motivated
• Collaborative
• Accepts and lives the company values
• Disciplined
• Team player
• Computer literacy essential (Word/Excel/Outlook)
• Problem solving skills
• Organisation Skills
• Excellent communication (verbal & written) interactive skills
• Complaints Management