Claims Assessor at Sanlam Group

Under general direction and within company guidelines will research, collates, records and examines complex claims to make long term claim settlement determinations. Within approved guidelines will approve claims. Will source inputs from claims consultant where necessary.
What will make you successful in this role?

• To assess each claim on the claim administration system and identify the type of claim
• Assess the validity of the identified claim by assuring all the supporting documentation has been submitted. (assess the documentation in terms of signed claim form, id of deceased, proof of bank details, death certificate, BI 1663)
• Valid claims are processes on the administration system and send for payment
• Claims that have outstanding documentation: client will be notified of outstanding requirement
• Invalid claims will be rejected/ Repudiated
• All claims processes must align to SLA and SOPS
• To maintain and error rating of less than 1 %
• Assure capturing of claims are done accurately
• Assure all criteria is met to pay claim
• Assure the quality of feedback (written and verbal) to clients
• To ensure that clients are provided with real time information on the status of the claim (feedback on the claim processing)
• Assure feedback on requirements for successful claims payment is done timeously

Qualification And Experience

• Grade 12 with 1 to 2 years related experience.

Knowledge And Skills

• Claims administration
• Claims settlements
• Claims approvals and rejections
• Operate within claims guidelines and compliance

Personal Attributes

• Self-development - Contributing independently
• Decision quality - Contributing independently
• Plans and aligns - Contributing independently
• Manages conflict - Contributing independently