Claims Assessor (Long Term Insurance) at Absa Group Limited (Absa)

Job Summary

To provide and maintain a consulting service to employers, retirement funds and other stakeholders with regard to employee benefit risk management and incapacity management in the work-place. This includes advice on benefit structures and management of ill or disabled employees in the work-place.

Job Description

Assessment of disability claim

• Obtain a completed claim pack
• Analyse the claimants medical condition, vocational requirements as well as fund/insurer rules and policies to determine the eligibility for benefits
• Consider the relevant Fund/Insurer rules and policies to determine a member’s eligibility for benefits eg determine if the members medical condition was pre-existing
• Evaluate the extent of a member’s disability against his/ her occupational duties
• Assess and Compile a recommendation on the validity of the claim to be submitted to the client in a written report
• Manage appeals arising by reviewing claim documentation against issues that are either medical and/or legal in nature. This includes determining and sourcing of new medical evidence and/or technical information and re-evaluation in terms of the rules of the Fund
• Provide medical and technical recommendation to the relevant Fund trustees

Consulting to clients on claims

• Respond to product queries from members and clients on claims and the related decisions and outcomes of these
• Respond to queries from members and clients on individuals claims applications telephonically and email
• Provide suggestions and advise to clients on the management of individual claims
• Provide suggestions and advice to clients on the management of the claims
• Discuss the disability reports with clients in order to identify trends and issues of concerns – and provide recommendations on interventions

Authorisation Of Member Risk Benefits

• Compilation of claim decision letter in terms of the medical, legal and financial outcome of the claim.
• Authorise payment of claims and medical accounts received from medical and paramedical practitioner

Reporting on claims

• Provide management information to clients on trends and statistics related to claims
• Ensure that the reports are sent to the clients according to the SLA’s in place

Disability Management

• Determine cases that require disability management based on medical diagnosis and prognosis
• Implement and monitor disability management programmes for all designated cases by obtaining feedback from relevant rehabilitation practitioners
• Assess viability, costs, duration and outcome of disability case management
• Recommend claimant return to work in their own role; a modified or completed alternative role; or submit for long term disability. Consult with line management to assist in finding a suitable alternative role for the claimant

Education

• Higher Diplomas: Business, Commerce and Management Studies (Required)