Job Description

Closing Date 2025/07/03
Reference Number MMH250626-1
Job Title Claims Assessor
Position Type Permanent
Role Family Client Services
Cluster Guardrisk
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Sandton
Introduction
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.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
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

Duties & Responsibilities

• 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

Competencies

• 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

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.