Financial Services Leader urgently seeks to appoint 10 skilled Life Claims Assessors on a 12 month contract.
Purpose of the role:
To effectively assess valid Death/Disability/Dread Disease/Retrenchment and Hospital Plan claims, on
non-underwritten products, accurately within specified turnaround times.
Duties and Responsibilities:
Accountability: Assessment of claims
- Access claims daily by logging into the administration system
- Ensure that the submitted documentation is clear and authentic. Verify the Life assured and claimant through
checking the details on the relevant Systems as well as against the client’s application form and Policy documents.
- Ensure every claim is assessed in accordance with the relevant policy terms and conditions.
- Contact the relevant third parties for required information (e.g. Police, medical personnel, medical aids,
employers, clinics, hospitals, etc).
- Identify suspicious claims and refer to the forensic investigator for further investigation.
- The assessor is responsible to make the decision on each claim and to motivate these decisions.
- Refer claims to the ex-gratia committee with a motivation where claimants request under exceptional
- Where applicable refer claims to unclaimed benefits.
Accountability: Customer experience
- Handle all walk in clients and telephone queries in a professional manner. If required transfer all non-claims
related queries to the relevant and correct department.
- Inform branch consultants and claimants when documents are received of any outstanding documents or claim
- Ensure that clients are advised in communication of the final decision what the status of the benefits claimed
against are, or if policy is ended due to the claim.
- Advice of claimant of the period of payment when monthly payments are made.
- All letters must be referred for authorizing before posting to the claimant.
- Produce all correspondence to the highest quality according to standards.
- Take responsibility and ownership off all queries received and finalize them speedily according to the SLA and
- Do regular follow ups on outstanding documentation needed for pending claims.
- Minimum of 4 years experience with specific understanding of the life insurance market
All appointments will be made in line with company EE requirements.