Claims Assessor Specialist

Overview

Discovery – Discovery Life

About Discovery

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Discovery Life

Discovery Life is an ever growing fast-paced and dynamic environment that provides innovative risk assurance to individual clients. This environment thrives on customer engagement and customer experience as well as mutually beneficial relationships with our brokers and other stakeholders. It is important for our employees to provide a world class service to our internal and external clients, thereby ensuring long and sustainable relationships.

Key Purpose

To ensure that the claims service strategy prevails in that adherence of the assessment of claims decisions are proved to the relevant stakeholders, in keeping with the business rules, set criteria and service level agreement discipline.

Responsibilities

• Decision making skills
• Effective independent assessment of complex claims within high authority limit and skill level to ensure accuracy of decision-making identifying material non-disclosure, misrepresentation or fraud.
• Demonstrate proficient service through formal communication to ensure adherence to communication standards. Building relationships with brokers and franchises, engages with top Premium platinum and Gold Prestige financial advisors to ensure successful execution of claims deliverables.
• Adherence to service level agreement discipline to ensure service standard.
• Attain a quality assurance of above 85% to ensure effective claims decision making and communication output.
• Coach and conduct training for junior or new assessing staff to ensure skills transfer and accurate decision making.
• Presents individual claims on disputes, declines, voids and reconstructs to various committees including medical, legal, underwriting, actuarial and compliance for verification.

Competencies & Skills

Decision making skills

Analytical skills

Effective communication skills

Attention to detail

Qualifications & Experience

Essential :

Matric

Diploma / Bachelor’s degree in health-related field (such as nursing, occupational therapy, psychology, physiotherapy, etc

4-5 years of working experience in claims assessment of all types of benefits e.g. Life cover, disability, severe illness and income protection claims in the long-term insurance industry.

Advantageous :

2-5 years underwriting experience in a long terms insurance industry

Risk management knowledge with experience of Individual Life claims assessment of all benefits.

Medical knowledge in terms of terminology and interpretation of medical reports.

EMPLOYMENT EQUITY

The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.

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