Assupol Life: Specialist-IL Claims Assessment

Company Assupol Life
Reference # SICA
Published 16/10/2020
Contract Type Permanent
Salary Market Related
Location Menlyn, Gauteng, South Africa
To validate and asses all death claims, ill health and disability claims
Job Functions Administration
Industries Financial Services,Insurance
Duties & Responsibilities:
1.Assessing and processing of life claims
•Process and approve life claims over R300 000 cover (Retirement annuities, 4sure policies, Endowment and progress legacy claims)
•Update notes on system
•Liaise with Re-insurers where necessary
•Follow up timeously on all outstanding claims
•Liaise with Hospital Superintend on long medical questionnaires and hospital files
•Interpret finding on the medical records
•Recommend for decline/payment of claims
•Liaise with specialist support on all the suspicious claims
•Liaise with specialist support on all ITC and tracing enquiries
•Monitor and report trends to manager
•Oversee funeral claims assessed by claims assessors as 2nd validators
2.Assessing and processing of rider benefit claims
•Process and asses Retirement annuities, Ill health and Disability claims
•Liaise directly with clients and send a detailed letter with all requirements
•Register and Validate all claims received
•Continuous follow up with in-house medical professional and consultant
•Appoint occupational therapist of a specific case
•Liaise with clients GP, hospital and the specialist.
•Obtain confidential information from the underwriting function
•Receive and acknowledge outstanding documents of claims (AIMS) received from clients
• Liaise with re-insurers on claims outside the treaty
•Recommend the decision of the claim to Manager
•Register risk claim on ASISA and liaise with other insurance companies carrying the same risk
•Draft letter to inform client if claim has been approved/declined
•Provide input to Underwriting department on trends and dispute claims
•Monitor and report trends to manager
•Respond to complaints and queries from clients, Ombudsman and legal entities
•Write letters to the estate where beneficiaries are unknown or they have passed on
•Continuous feedback to clients as some of the claims might take longer than anticipated (up to 24 months)
•Prepare stats for management report
3.Oversee the assessment and finalized B3 Claims
•Writing and sending letters for all claims finalized
•Ensure claims are scanned and originals are kept for auditing purposes
•Prepare audit for all B3 claims
•Send reminders to assessors, to ensure claims is processed and finalized
•Provide input to management and B3
4.Recommendation of complex claims
•Identifying disputes and complaints of complex claims (Life policies above R300 000 and Rider benefit claims)
•Recommend a solution to Senior Manager
5.Reconcile information received, processed and finalised
•Compile monthly individual statistics
•Compile reports as requested by managers (for audit purposes)
•Compiling all branch registers month end (Death and Rider benefit claims)
1. Formal Education
•Degree: Business Administration/ 3 years or longer relevant qualification
•Health background (Advantage)
2. Technical/Legal Certification
•FAIS, FICA, LTIA, Medical Terminology and understanding
3. Experience
•4-5 years claims assessment
4. Knowledge
•Legislation – FAIS, FICA, FSB, NCA, LTIA
•Life Insurance Industry
•Long Term Insurance Claims
5. Skills
•Computer Literacy
•Report Writing
•Problem Solving
6. Attributes
•Team Player
•Control Procedures
•Attention to detail
•Planning & Organising
Job Closing Date 26/10/2020