Claims and Underwriting Administrator at Discovery Limited

Key Purpose of the role

• Assisting the underwriters with general administration related to underwriting. Ensure brokers are well informed by providing accurate information to them in order to adequately support clients. Compile underwriting status reports. Provide or receive half cost medicals from other insurers. Ensure claim assessments and payment of lump sum benefits (Funeral, death, SIB and ICB) payments.

Principle Accountabilities

• Enhance group risk revenue and profit streams to meet business objectives through the following:

Claims:

• Compile claims reports for brokers from SFE and Compass
• Pre-assess or review disability claim applications as per process
• Manage claim related queries and provide the client with feedback thereof
• Receive claims from indexing department for assessment of the funeral and death claims - member; child or spouse claims as well as extended family members.  Assess each claim by verifying claim details against standard claims requirements.  Liaise with Broker should documentation not be in order
• Should discrepancies be picked up, refer the documentation to the Forensics Department.  Ensure regular follow-up until Forensics provide an investigation outcome
• Once all documentation has been received, set up payment on the system for verification by second Assessor and Authoriser
• Receive claims for verification (second assessing) and authorizing
• Issue payment letters and/or claims decision letters to Brokers once payment has been approved

Underwriting:

• To send medicals requirements requests to brokers/SC in order to be completed by member for underwriting members’ over the acceptable limit
• Link the received completed medicals to the system and allocate to the underwriters for a decision
• Ensure all documents submitted are correct and completed in full.  Where documents are missing, source the documents from Meditech or other Pathologists
• Once all documentation is attached on SFE, complete audit for Member and move it to the Underwriters
• Compile underwriting admin reports for brokers from SFE and Compass
• Investigate reasons for anomalies on any underwriting admin process and troubleshoot. Look out for members that need decisions to be re-applied
• Deal with escalated calls or queries to ensure high quality

Education and Experience

• Matric - Essential
• Relevant Industry Qualifications – Advantageous
• MS Office experience especially Excel and Compass- Essential
• Group Life/Risk Insurance experience- Essential
• 3 to 5 years working experience within a Group Life Administration environment