Claims Assessor Specialist 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 claimsaccording 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

• 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 and resolution
• Collaboration and team work
• Learning and Researching
• Delivering Results and Meeting Customer Expectations
• Following Instructions and Procedures
• Adapting and Responding to Change
• Coping with pressure and setbacks
• Achieving Personal Work Goals

Education and Experience:

Education

• Matric/Grade 12 is essential
• A minimum of 5 years prior experience within a claims environment in the life insurance industry is essential.
• COP (Certificate of Proficiency) in life insurance would be advantageous.
• Medical degree or diploma would be advantageous.

Knowledge:

• Microsoft Office skills, i.e. Outlook, Excel and Word are mandatory.
• Extensive knowledge of the Life Insurance Industry.
• Experience within the UK Life Claims environment would be advantageous.
• An advanced level of understanding of Medical conditions and diagnoses
• An advanced level of Communication Skills (verbal & written)
• An intermediate level of conflict handling