Claims Assessor: Life

at  Pro Talent

INSURANCE

PURPOSE OF THE ROLE: Responsible for validating, evaluating, making the correct assessment decision and calculating the correct settlement for CPP (Life) Claims assessed.

KNOWLEDGE, SKILLS AND BEHAVIOURS:

• Good understanding of the claims assessment process.
• Detailed knowledge relating to the specialist/technical nature of life claims assessment.
• Good understanding of medical conditions and the ability to understand medical terminology and medical reports.
• Logical and analytical and able to make accurate, complete deductions from multiple sources of information received in respect of the claim.
• Knowledge of the relevant policies and the ability to understand and interpret relevant policy wordings.
• Able to make correct and timely decisions as informed by policy wordings.
• Good communication skills, both written and verbal.
• MS Office Skills including Excel.
• High levels of attention to detail to ensure accuracy and completeness.
• Ability to apply judgement and tact when providing explanations.
• Ability to manage policy holder expectations.
• Ability to work independently and demonstrate initiative.
• Team orientation. Committed to team goals, targets and objectives.
• Good organisational and time management skills. Able to plan and prioritise in order to meet deadlines.
• Results focused.
• Quality orientation.
• Customer service orientation.
• Integrity.
• Empathetic, patient and tolerant.
• Diplomatic and mindful of impact.
• Cross cultural awareness.
• Assertive and confident.
• Ability to interpret medical reports.

EDUCATION/EXPERIENCE REQUIRED:

• Matric.
• Minimum Qualification: Relevant NQF 4.
• A medical qualification would be an advantage.
• Preferred Qualification: Further Education and Training Certificate (FETC) in Short Term Insurance, Long Term Insurance or Retail Insurance.
• FAIS Regulatory Exam for Representatives (RE5).
• At least 2 – 4 years’ work experience as a Life Assessor is required.
• Previous work experience in long term insurance services, financial services or an insurance company would be most valuable.
• Relevant technical knowledge to understand the technical requirements of life assessment is required.
• A good understanding of general financial concepts is required.
  Applications to be sent to nicola@proappoint.co.za with the subject: Life Claims Assessor
  Education / Experience

• Support all involved stakeholders with regard to claim queries.
• Ensure that all interactions and developments are well documented on IUA inhouse systems.
• Ensure optimal use of MOS to manage workload.
• Responsible for generating payment requisitions to facilitate claim payments.
• Assume overall responsibility for the content of the decision notification sent out to all relevant parties.
• Will work on the queries on the Assessor 1 queue.
• Will attend to ad hoc business partner queries.