Overview
Claims Assessor Jobs in Sandton at Guardrisk
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
Title: Claims Assessor
Company: Guardrisk
Location: Sandton
