Claims Assessor at Discovery Limited

Key Purpose

The role contributes to the organisational goals by assessing, validating and finalising of all Life Cover, Serious Illness Cover, Income Protection Cover, Disability Cover claims according to the policy terms and condition whilst still adhering to service level agreements and maintaining high service standards.

Areas of responsibility may include but not limited to:

• The successful applicant will be responsible for but not limited to the following job functions:
• Assess and decide on validity of claims submitted.
• Medical and financial assessing of Protection claims.
• Assessing the contract validity of a claim.
• Identifying possible fraud, non-disclosure, misrepresentation and pre-existing conditions.
• Liaising with internal and external stakeholders to reach claim decision.
• Provide input into product development and system enhancements
• Complaint resolution
• Coaching of administrators

Personal Attributes and Skills:

• Strong Relationships Skills.
• Deciding and initiating action
• Working with People
• Able to work unsupervised and to take initiative
• Adhering to Principles and Values
• Presenting and Communicating Information
• Conflict handling
• Analysing
• Learning and Researching
• Delivering Results and Meeting Customer Expectations
• Following Instructions and Procedures
• Adapting and Responding to Change
• Coping with extreme pressure and setbacks
• Achieving Personal Work Goals

Education and Experience:

Education

• Matric / Grade 12 is essential.
• COP (Certificate of Proficiency) in life insurance would be advantageous.
• Medical degree would be advantageous.
• An intermediate knowledge of the Life Insurance Industry.

Knowledge:

• Microsoft Office skills, i.e. Outlook, Excel and Word are mandatory.
• Previous life claims assessment would be advantageous.
• An intermediate to advanced understanding of Medical conditions and diagnosis
• An intermediate level of Communication Skills (verbal & written)
• An intermediate level of conflict handling

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.