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Assessor : Medical Claims
CapitecBellville, Western Cape, South Africa1 day ago
Job descriptionA Health Science degree in BSC in Occupational Therapy, BSC in Physiotherapy or BSC in Nursing (Registered Nurse) 3-5 years’ experience in assessing life and disability insurance claims in the long-term insurance environment with proven experience in stakeholder management and client engagement 3+ years disability claims assessor experience Understanding of the long-term insurance industry and life and disability claims handling processes, specifically related to the medical claims landscape Strong knowledge of life and disability assessment standards and guidelines Comprehensive knowledge and understanding of relevant legal framework relating to life and disability / medical insurance claims Investigative tactics, tools and methodologies Understanding of the Insurance fraud landscape Verify and assess documents for life and disability claims to ensure they are legally valid Assess the validity of life and disability claims accurately and holistically and make a decision within the agreed turnaround times, maintaining high standards of quality and consistently meeting or exceeding productivity standards and set targets and in accordance with the terms and conditions of the policy, legislative frameworks, claims frameworks, claims process and procedure, authority limits, goals and objectives and any standards sets by Capitec Insurance. Identify and escalate risks, including fraudulent claims, in line with Capitec’s Fraud Prevention and Identification Framework. Identify trends and areas of concern and escalate accordingly. Plan and execute to ensure that all the required checks on claims are executed, with a specific focus on early claims Participate in the analysis of results and provision of statistics that will inform managerial decision making. Process claims within the pre-determined time limits. Respond and resolve claims queries and complaints within service level agreements Build trusting relationships with internal and external stakeholders to achieve Capitec Life objectives. Educate stakeholders on their responsibilities regarding the Claims Assessment Framework. Provide effective, efficient, and professional service to all customers through their preferred channels. Liaise with third parties to gain additional facts and information about the respective event. Administration Skills Attention to Detail Decision making skills Numerical Reasoning skills Planning, organising and coordination skills Clear criminal and credit record
Overview
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We\'re on the lookout for energetic, self-motivated individuals who share our passion for service in the banking industry. To be part of the journey, follow the steps below :
- To see what life at Capitec is all about and complete a short assessment, please click here!
- Once you have completed the above finalize your application by clicking apply below
Purpose Statement
To improve claims operational excellence, increase customer satisfaction, minimize losses for Capitec Insurance through accurate and holistic assessment of life and disability claims, in accordance with terms and conditions of the respective policy / ies, legislative frameworks and goals, objectives, processes and standards sets by Capitec.
Location
Century City
Qualifications
Experience
Minimum :
Ideal
Knowledge
Key Performance Areas
Medical Claims Assessment and Oversight
Medical Claims Queries and Complaints
Stakeholder engagement
Skills
Conditions of Employment
Capitec is committed to diversity and, where feasible, all appointments will support the achievement of our employment equity goals.
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Medical • Bellville, Western Cape, South Africa
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