Life Claims Assessor 12 Months Contract at Rand Mutual - RMA

Purpose

• To effectively and efficiently process and adjudicate Funeral Fund Claims, within the scope of the Funeral Fund policy rules and prevailing legislation. Also, to enhance and improve customer experience through effective assessment of claims and meeting the requirements and expectations of the role set out below.

Requirements

Qualifications and Experience required

• Grade 12
• A National Diploma or Degree (minimum NQF level 5)
• Computer literacy: Advanced MS Word, Excel and Outlook
• Insurance Qualification (advantageous)
• 1-year industry experience (minimum)
• Regulatory Exam

Key Areas of responsibility

• Effectively and efficiently perform the function of a Funeral Claims Assessor:
• Assess all funeral claims for validity and process for approval
• Communicate outstanding requirements to brokers/clients on pending claims, according to the follow up process and procedures
• Adhere to a 24-hour turnaround time for all funeral claims
• Finalise each claim on system e.g. Correct claim status should reflect (Paid/Declined/Pending/Closed/Unclaimed)
• Draft and forward payment and repudiation letters for all funeral claims on the same day in which the claim was finalised
• Update notes with comments regarding the progress of the claim
• Ensure that the assessment synopsis is correctly executed under notes on the system and that the assessing decision is done in the correct format as set out in the process and procedures documents
• Assist with walk in clients when required
• Deal with complaints received on claims from clients/brokers
• Follow all referral criteria e.g. Forensics
• Ensure all scanned documents have been indexed correctly
• Management of notifications
• Follow up on notifications where full claims have not yet been received
• Management of the timeous finalization of claims
• Adherence to company standard operating procedures
• Ensure that the highest quality is maintained, and that the communication sent to clients/brokers is double checked for validity and accuracy
• Deal with claims assessing escalations
• Utilise validation tools as set out in the claims process e.g. XDS, VOPD etc.

Adjudicate and process payments for claims

• Adjudication and processing of funeral and death benefits including approval within authority limits.
• Adjudicating and processing payment of critical illness within authority limits.
• Adjudicate Permanent Disability claims.

Knowledge, Skills and Competencies required

• Knowledge of administrative and clerical procedures
• Telephone skills – Advanced
• System navigation skills – Intermediate
• Customer interfacing skills (face to face/written/telephonic) – Advanced
• Computer literate - MS Office - Intermediate
• Numeracy
• Knowledge of Customer Service principles and practices
• Multilingual
• Excellent Keyboard skills
• Good Administrative skills
• Good communication skills, verbal and written
• Ability to work under pressure, be target driven and meet deadlines
• Own Transport
• Valid Driver’s License
• Regulatory and Long Term Insurance Compliance procedural knowledge
• Timeous handling of work assigned.
• Availability of information to the manager for decision-making
• Applied Learning
• Building Customer Loyalty
• Contributing to Team Success
• Managing Work (includes Time Management)
• Initiating Action
• Stress Tolerance
• Decision Making
• Conflict Management skills
• Adapting and responding to change
• Following instructions and Procedures
• Learning and researching
• Relating and Networking
• Achiever
• Confidentiality
• Credibility
• Customer Service Orientated
• Friendly
• Objective
• Integrity & Honest
• Information and Information Management And Analysis Patient
• Project wide perspective
• Resilience
• Resourceful
• Self-motivated
• Driven
• Goal and target orientated