Claims Consultant Johannesburg - Johannesburg
Select Resourcing Pty Ltd
My client is a dynamic and vibrant player in South Africa's financial services industry. They are passionate about financial services and the good it can do. Claims Consultant: The purpose of this role is responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and accurate decisions on claims worked on. Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work. Duties: 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 Qualifications: Grade 12 (Essential) Relevant tertiary qualification; a medical degree preferable Experience: • Minimum 2-3 years experience in Life Insurance Assessing • Medical Background • Experience in both group and life individual life claims (Essential) • Sound Business and Operational knowledge of Insurance Industry administrative processes • Good knowledge of the business administration platforms R25000 to R30 000pm
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