JOB TITLE: Life Claims Assessor AREA: Waterkloof, Pretoria East INDUSTRY: Insurance Salary / CTC: R 32 000 Report to: Claims Manager Job Overview: Our Client is currently seeking a highly motivated and detail-oriented Life Claims Assessor with specialised knowledge in insurance claims related to retrenchment, disability, dread disease and death. This role is integral in ensuring that our policyholders receive accurate and efficient claim assessments and settlements. The Life Claims Assessor will be responsible for evaluating and processing claims in these specific areas, requiring a deep understanding of policy terms and related conditions. Responsibilities: Claims Evaluation: Assess life insurance claims related to retrenchment, disability, dread disease and death. Review and verify policy terms, eligibility, and coverage. Investigate and analyse the circumstances surrounding each claim to determine its validity. Assess claims consistently and ensure that claims assessments and practices are in line with the market, and with the company values. Liaison with relevant Third Parties Liaise with relevant third parties when necessary to assess disability, dread disease and death claims. Collaborate with healthcare professionals to evaluate complex medical claims. When dealing with retrenchment claims, verify the employment history and retrenchment circumstances. Assess the impact of retrenchment on the policyholder's ability to meet premium payments. Documentation: Maintain organised claim files and ensure all required documentation is completed and up to date. Prepare and submit necessary reports and recommendations. with relevant Third Parties: Client Communication: Interact in a professional, and empathetic manner, with policyholders and beneficiaries. Provide clear explanations and updates on claim status, outcomes and the reasons for it. Adjudication: Determine the eligibility of claims and calculate claim benefits accurately, taking into account policy terms, conditions, and exclusions. Process claims benefits in a timely manner. Quality Assurance: Continuously improve claim assessment processes to enhance efficiency and accuracy. Identify potential fraud and escalate suspicious claims as needed. Compliance: Stay updated regarding industry regulations and company policies. Ensure all claims are processed in compliance with legal and ethical standards. Qualifications: Must have a Diploma / Bachelor's degree in a relevant field such as Insurance, Finance, or a related discipline such as Healthcare. RE5 & full FAIS qualifications will be beneficial, but is not required. Work experience: Experience: 3- 5 years previous experience in life insurance claims assessment with a focus on death, retrenchment, disability, and dread disease claims. Knowledge: Regulatory Knowledge: comprehensive knowledge of insurance regulations and laws specific to South Africa. Healthcare knowledge: comprehensive knowledge medical practices. Personal attributes: Excellent analytical and problem-solving skills. Attention to detail. Being organised. Excellent communication skills.
