Role Purpose
The successful incumbent will be responsible for assessing, reviewing, and managing living benefit claims in accordance with relevant legislation and company policy, while adhering to Service Level Agreements and meeting client and business expectations.
Requirements
Relevant degree or qualification (Desirable)
Grade 12 or equivalent qualification (Essential)
1-2 years experience in processing claims
Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (Desirable)
Knowledge of relevant legislation and industry regulations
Knowledge of the claims assessment process (paper and EDI)
Knowledge of the relevant scheme or product rules
Knowledge of relevant claims operating systems and tools
Duties & Responsibilities
Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level agreements.
Partner and collaborate with relevant stakeholders, to improve claims assessment and the client's claim experience.
Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation.
Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
Give input into and review claims policies, practices, forms and documentation to ensure that risk management standards are met and aligned to relevant product changes and legislative updates.
Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required.
Competencies
Analytical skills
Attention to detail
Interpersonal skills
Communication skills
Service orientation
Prioritisation skills
Problem solving skills
Closing Date
2026/04/23