Our client in the Insurance industry is looking for an Administrator: IL Claims Assessment.
1. Assessing and processing of life and funeral claims • Process funeral and life claims and prepare for claims approval process within 48hrs of receipt • Verify premiums paid on the system prior to assessing claims • Verify deceased and beneficiaries against main policy on the system • Confirm the policy holders relationship to the deceased • Liaise with Re-insurers where necessary on Life cover policies below R300 000.00 • Refer suspicious fraudulent claims to Specialist administrator • Discuss complex claims with in-house professional advisor and consultants • Follow up timeously on all outstanding claims • Liaise with relevant stakeholders on outstanding and incorrect Id numbers and where the person is covered on the application form but does not exist on the system • Liaise with Client services where the deceased died before the policy become inactive. To activate the policy prior to assessing • Responsible for identifying disputes and complaints of complex claims • Recommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expires • Update AIMS notes on system • Be a 2nd validator on captured and authorized claims • Give feedback on follow-up claims to Section leader • Forward a spread sheet of all finalized claims to Section Leader
2. Claims pay-out • Confirm status of the claim if it is approved or declined • Where the age of the deceased differ with the one on the system apply the penalty formula • Recommend decline/payment of claims • Double check the consistency on banking details attached to the claim and the one on the system • Forward the claim to Manager for payment • Check the finance list and sign off
3. Reconcile information received, processed and finalized • Compile monthly individual statistics • Compiling all branch registers month end (Death) • Present challenges experienced and solutions taken to resolve them
Requirements • Matric • NQF 4 in Insurance (Advantage) • 2 years life insurance in claims • Intermediate MS Office Word, Excel, PowerPoint