Claims Consultant Sandton - Sandton
Moving Heads Personnel
EXPERIENCE IN BOTH GROUP AND INDIVIDUAL LIFE CLAIMS IS ESSENTIAL Evaluate claims forms and supporting documentation in preparation of making an payment decision Gathering information and various types of reports from medical practitioners Compare the reorts to our exisitng claims criteria to establish if claim is payable Decide on levels of provisions to be raised based on information received Writing claims assessment standards/policies Auditing/QA of work done by peers Deliver claims payment decision Determine requirments / documents required to evaluate claims Liase with relevant re-insurers to determine validity of claims and get their approvals where required Explain and communicate final decisions to brokers and clients Create schedules for payments and obtain relevant approvals Grade 12 Relevant tertiary qualification; a medical degree preferable Min 2-3 years experience in Life Insurance Assessing Medical Background Experience in both group and life individual life claims is essential Sound Business and Operational knowledge of Insurance Industry administrative processes Good knowledge of the business administration platforms Familiar with Compliance Processes and Procedures in the Insurance Industry Familiar with the business products and their rules and workings Negotiable
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