RESPONSIBILITIES<\/p>\n
Claims Data Collection & Analysis<\/p>\n
\tAsk questions, collect data from a variety of sources, analyse information and investigate claim. Ensure that the client policy is valid through the appropriate due diligence (such as listening to the policy sales\/retention etc. phone conversation.
\n\tCheck claims and validate contracts on claims, that are above claims assessor limits by reviewing claims decisions made by life claims assessors, by applying specialist medical assessing skills and knowledge and experience.
\n\tMedically assess the validity of the claim by applying specialist medical assessing skills and knowledge.
\n\tEnsure that relevant waiting periods have expired and that all premiums have been received on the policy.
\n\tAudit claim decisions made and processes and procedures followed by life claim assessors during the assessment process.
\n\tEnsure that the correct decision is made with regards to acceptance\/declining payment of claim based on appropriate documents received and relevant\u00a0 contract in place.<\/p>\n
Correspondence<\/p>\n
\tEnsure that a claimant is kept informed at all times with regards to their claim process. To ensure that the appropriate settlement documentation is sent to the appropriate parties outlining the amounts paid and the reasons for it; and ensure that the relevant parties for a declined claim are contacted and the reasons for the claim being declined is explained thoroughly.
\n\tEnsure that relevant claims correspondence is forwarded to the reinsurer.<\/p>\n
Customer Management (Internal and External)<\/p>\n
\tHelp manage customers by carrying out activities to complete the customer request. Provide feedback to the complaints department on customer complaints and queries regarding outcome of claims decision.
\n\tAdhere to SLAs between claims and the complaints department and providing the complaints department with comprehensive feedback on the background of the claim and decision made.
\n\tComply with current claims policy and procedures and ensure that production targets are met and that relevant turnaround times and SLA’s are adhered to.
\n\tTo appropriately escalate any red flags \/ discrepancies to the relevant department (for example forensics) as and when identified.<\/p>\n
Administration<\/p>\n
\tTo ensure that the correct banking details are received and captured and that the correct amount in terms of an accepted claim is paid to the appropriate parties.
\n\tEnsure that all appropriate documents are in place relating to a client policy and ensure that the appropriate disclosures were made by the life assured.
\n\tEnsure claims statistics are updated correctly and timeously and that all internal and external communication regarding the claim is stored on the relevant folder.<\/p>\n
Continuous Improvement<\/p>\n
\tLeverage all available information from our partners, the industry, and internally to ensure we are constantly reviewing our departmental processes, systems and protocols with a view to improve efficiencies. Analyse current performance inhibitors and finding solutions to ensure business continuity.<\/p>\n
Personal Capability Building<\/p>\n
\tDevelop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.<\/p>\n
Performance Management<\/p>\n
\tPrioritise own workflow and ensure work is completed to the required standards of productivity, quality and timeliness.
\n\tMonitor the performance of the team; allocate work and review completion, take appropriate corrective action to ensure timeliness and quality. Ensure that production targets are met and that relevant turnaround times and SLAs are adhered to.<\/p>\n
Organisational Capability Building<\/p>\n
\tProvide instruction and informal advice to less experienced colleagues within the team to develop their skills.<\/p>\n
EDUCATION<\/p>\n
General Education<\/p>\n
\tGrade 12\/ SAQA Accredited Equivalent (Essential)
\n\tRecognized FSCA qualification (Essential)
\n\tRegulatory exam 5 (Essential); Nursing\/relevant medical qualification (Advantageous)
\n\tClass of Business Certification (Advantageous)<\/p>\n
EXPERIENCE<\/p>\n
General Experience<\/p>\n
\t4 or more years claims assessing experience in the life insurance industry
\n\t(Essential); Experience in a medical environment (Advantageous)<\/p>\n
Managerial Experience<\/p>\n
\tExperience of general supervision of more junior colleagues (Advantageous)<\/p>\n
Apply via company website ( www.nfosa.co.za ) or<\/p>\n
1life.mcidirecthire.com<\/p>\n
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