Description

THE JOB AT A GLANCE

• As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.

WHAT WILL YOU DO?

Claims Adjudication:

• Verify claims captured for correctness and compliance
• Capture / accept additional information on claims i.e. medical reports
• Ensure all documents required to process a claim are indexed and filed into the system
• Add meaningful and accurate notes to ensure complete synopsis of claim on the system
• Update requirements on claims and ensure they are always accurate and up to date.

Claims Management:

• Manage claims in line with individual targets
• Review of claims in line with process, authority limits and within agreed timelines
• Escalate where required within authority limits
• Management of medical reports for claims with Permanent Disability
• Communicate claims process to both the employer and employee as set out in the claim’s management processes
• Timeous management of workflows and notifications.

Adjudicate and process payments for claims:

• Adjudication and processing of TTD benefits including approval within authority limits
• Adjudicating and processing payment of sundry invoices within authority limits
• Process Permanent Disability claims.

Customer Service:

• Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
• Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
• Manage walk-in queries as and when required in line with the RMA Service Catalogue
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Provide customers with accurate product and service information in an efficient manner
• Update existing customer personal information on the system
• Deal with all customers in a professional and empathetic manner.

Requirements

WHAT YOU’LL BRING TO THE TABLE?

• FAIS Regulatory Examination (RE5) (Essential)
• NQF Level 5 Higher Certificate in a FAIS Recognised Qualification (Essential)
• A medical qualification (Advantageous)
• 3 to 5 years claims related experience (Essential)
• Intimate knowledge of the COID Act
• Good Administrative skills
• Advanced Excel Skills
• Knowledge of Claims processing, approval
• Insurance and/or Medical Aid experience
• Deadline driven