Technical Claims Assessor at Nedbank

Job Purpose

• To accurately assess, investigate, and process long-term insurance claims, including death, disability, and critical illness claims, and ensure prompt and fair payment of benefits in accordance with the policy terms and conditions.

Job Responsibilities
Stakeholder Engagement:

• Develop effective relationships with stakeholders (internal - client solutions team/client experience and external clients hospitals, doctors, labs, and reassurers).
• Drive and support effective teamwork within the department.
• Effective client communication throughout the claims journey.
• Ensure information is provided correctly to stakeholders by maintaining and     sharing knowledge.
•  Process Management
• Meet client needs by ensuring claims are processed according to service level agreement and insurance policy terms and conditions.

Job Responsibilities Continue
Professional Development:

• Engage in appropriate training interventions to promote own professional development.
• Adhere to organizational best practice and legislative requirements.
• Keep abreast of legislation and other medical industry changes that impact on the role by reading the relevant newsletters, websites, and attending sessions.
• Improve personal capability and stay abreast of developments in the field of expertise by identifying training courses and career progression for self through input and feedback from managers.
• Ensure personal growth and enable effectiveness in performance of roles and responsibilities by ensuring all learning activities are completed, experience practiced, and certifications obtained and/or maintained within specified time frames.

People Specification
Essential Qualifications - NQF Level

• Matric / Grade 12 / National Senior Certificate
• Professional Qualifications/Honour’s Degree

Preferred Qualification

• Physiotherapy/ Occupational Therapy/ Nursing/ Junior Doctor/ Medical related degree

Essential Certifications
Preferred Certifications

• Beneficial: Higher Certificate in Long Term Insurance

Minimum Experience Level

• 3 - 6 years
• 2 - 3 years Long Term Insurance

Technical / Professional Knowledge

• Administrative procedures and systems
• Insurance Policy Technical Knowledge
• Business principles
• Governance, Risk and Controls
• Relevant regulatory knowledge
• Relevant software and systems knowledge
• Business writing skills
• Medical and Financial Knowledge
• General Communication Skills

Behavioural Competencies

• Customer Orientation
• Collaborating
• Monitoring Information
• Decision Making
• Initiating Action
• Work Standards
• Planning and Organizing
• Communication