Risk Claims Assessor - Johannesburg at FirstRand Group

Job Description

Accurate assessment, investigation and management of long-term insurance claims in accordance with the goals, objectives, processes and standards of the organization to meet customer expectations.

• Accurate assessment, investigation and management of long-term insurance claims including Health (hospital) Cash claims and critical illness claims.
• Ensuring that the claims assessment and that the standard of decision is consistent with the company values and philosophy.
• Ensuring all risks are mitigated and escalated, this includes the identification of fraudulent activity, policy abuse and pre-existing conditions.
• Providing effective, efficient and professional service to all our customers, advisors and branches, both telephonically and through written correspondence.
• Taking ownership of queries and ensuring they are resolved timeously and effectively.
• Ensuring adherence to organisational best practice and legislative requirements.
• Teamwork to meet service and quality standards.
• Deliver exceptional service that exceeds customers’ expectations through proactive, innovative and appropriate solutions.

Additional Requirements

• At least 2 years’ medical claims assessment experience
• Worked with hospitalisation or similar claims
• Worked in a Long-term insurance environment
• Experience in dealing with Ombudsman / escalated queries

Qualifications and Experience

• Minimum: Matric
• Nursing background will be advantageous