THE JOB AT A GLANCE
As a Life Claims Assessor, reporting to the Claims Manager: Life, you will be responsible for adjudicating and processing claims effectively and efficiently within the prescribed guidelines set out by Rand Mutual Assurance.
WHAT WILL YOU DO?
Effectively and efficiently perform the function of a Funeral Claims Assessor:
Assess all funeral claims for validity and process for approval.
Communicate outstanding requirements to brokers/clients on pending claims, according to the follow-up process and procedures.
Adhere to a 24-hour turnaround time for all funeral claims.
Finalize each claim on the system (e.g. Correct claim status should reflect: Paid/Declined/Pending/Closed/Unclaimed).
Draft and forward payment and repudiation letters for all funeral claims on the same day in which the claim was finalized.
Update notes with comments regarding the progress of the claim.
Ensure that the assessment synopsis is correctly executed under notes on the system and that the assessing decision is done in the correct format as set out in the process and procedures documents.
Assist with walk-in clients when required.
Deal with queries received on claims from clients/brokers.
Follow all referral criteria (e.g. Forensics).
Ensure all scanned documents have been indexed correctly.
Management of notifications.
Follow up on notifications where full claims have not yet been received.
Management of the timely finalization of claims.
Adherence to company standard operating procedures.
Ensure that the highest quality is maintained, and that communication sent to clients/brokers is double-checked for validity and accuracy.
Deal with claims assessing escalations.
Utilize validation tools as set out in the claims process (e.g. XDS, VOPD).
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.
WHAT WILL YOU GET IN RETURN?
We offer great opportunities for personal and professional development in a stable company that's 130 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.
Turnaround time
The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days, please consider your application unsuccessful.
Our Commitment to transformation:
In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.
WHAT YOU'LL BRING TO THE TABLE?
Grade 12 qualification/Matric Certificate.
FAIS Regulatory Examination (RE5) Certificate.
NQF Level 5 Higher Certificate in a FAIS Recognised Qualification.
A medical qualification would be advantageous.
Insurance Qualification (advantageous).
3 to 5 years claims-related experience.
General knowledge of the LTI Act.
Intimate knowledge of the FAIS Act.
Intimate knowledge of the GCOC.
Intimate knowledge of the Insurance Act.
General knowledge of the ASISA Standards and Guides.
Good Administrative skills.
Advanced Excel Skills.
Knowledge of Claims processing and approval.
Long Term Insurance experience.
Deadline driven.
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