Living Benefits Claims Consultant at Sanlam Group

What will you do?

• Assessment and independent decision making of complex living benefits e.g. severe illness, disability and sickness benefit claims.
• Ensure that the client’s claim request is met within the boundaries of the policy contract, which includes the interpretation of contractual definitions.
• Liaise with relevant stakeholders (e.g. Underwriters, Legal Department, Product Development, Medical Doctors, Re-insurers) to resolve complex assessments.
• Propose improvements to the assessment process.
• Written and verbal communication with clients, intermediaries, underwriters and doctors during the assessment process and on outcome of the claim.
• Taking full ownership for the communication of the outcome of the claim to the client and intermediary that enables them to understand the decision and prevent complaints.
• Complaints handling.
• Contact person to VIP intermediaries for technical enquiries and their client’s claims.
• What will make you successful in this role?

Knowledge & Experience:

• Experience as an Occupational Therapist or clinical role in the medical field
• 5-7 years’ experience in the assessment of Living Benefit Claims or Risk claims is recommended.
• Experience in complaints handling
• Knowledge of Risk Products and Benefits is recommended
• Competencies:
• Manages complexity
• Good communication skills in English and Afrikaans (written and verbal)
• Working independently 

Qualification and Experience

• Degree or Diploma with up to 5 - 7 years related experience.
• Knowledge and Skills
• Claims administration
• Claims settlements of a complex nature
• Claims approvals and rejections
• Operate within claims guidelines and compliance
• Coach and develop others
• Personal Attributes
• Business insight - Contributing independently
• Manages complexity - Contributing independently
• Plans and aligns - Contributing independently
• Manages conflict - Contributing independently