Administrator

Our client in the Insurance industry is looking for an Administrator: IL Claims Assessment

We are seeking a detail‑oriented professional to manage life and funeral insurance claims, ensuring accuracy and timely processing.

Key responsibilities

1. Assessing and processing of life and funeral claims

• Process funeral and life claims and prepare for claims approval within 48 hours of receipt.
• Verify premiums paid on the system prior to assessing claims.
• Verify deceased and beneficiaries against the main policy on the system.
• Confirm the policy holders relationship to the deceased.
• Liaise with re‑insurers where necessary on life cover policies below R300 000.00.
• Refer suspicious fraudulent claims to Specialist administrator.
• Discuss complex claims with in‑house professional advisor and consultants.
• Follow up timeously on all outstanding claims.
• Liaise with relevant stakeholders on outstanding and incorrect ID numbers and where the person is covered on the application form but does not exist on the system.
• Liaise with Client services where the deceased died before the policy became inactive; activate the policy prior to assessing.
• Identify disputes and complaints of complex claims.
• Recommend a solution to Senior Manager where a claim arises a day before the 6‑month waiting period expires.
• Update AIMS notes on system.
• Act as 2nd validator on captured and authorised claims.
• Provide feedback on follow‑up claims to Section leader.
• Forward a spreadsheet of all finalised claims to Section Leader.

2. Claims pay‑out

• Confirm status of the claim if it is approved or declined.
• Apply the penalty formula where the age of the deceased differs with the one on the system.
• Recommend decline/payment of claims.
• Double‑check consistency of banking details attached to the claim and those on the system.
• Forward the claim to Manager for payment.
• Check the finance list and sign off.

3. Reconcile information received, processed and finalised

• Compile monthly individual statistics.
• Compile all branch registers month end (Death).
• Present challenges experienced and solutions taken to resolve them.

Requirements

• Matric.
• NQF 4 in Insurance (advantage).
• At least 2 years of life insurance claims experience.
• Intermediate proficiency in MS Office Word, Excel, and PowerPoint.

Send your CV and latest pay slip to raca@aaaa.co.za

ATripleA Recruitment and Temps
www.aaaa.co.za

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