What youll be doing if you get the job: The purpose of this role is 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. Wholl you report to: Youll be based at our head office in Sandton, Johannesburg. Youll report to the Head of Claims responsible for Claims. Your qualifications: Grade 12 (Essential) Relevant tertiary qualification; a medical degree in Nursing, Occupational Therapy, Physiotherapy is preferred Your Outputs (include but is not limited to) : 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 in line with standards/policies Auditing/QA of work done by peers Deliver claims decisions within the expected turnaround time 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 Communicate with relevant stakeholders throughout the claims process Assist other team members with complex matters Adhoc project involvement Perform validation of policies in line with business and industry standard rules. Your experience: Minimum 3-5 years experience as a Claims assessor, preferably in a Senior position Experience in both group and life individual life claims (Essential) Sound Business and Operational knowledge of Insurance Industry administrative processes Good knowledge of the business administration platforms Familiar with Compliance Processes and Procedures in the Insurance Industry
