Claims Assessor

SUMMARY:
Area/Location: Cape Town
 
Our Insurance Client is seeking a Claims Assessor in their Gap Claims Assessing Department

POSITION INFO:
Job description & duties:

• The duties for which you will be responsible in terms of this contract are briefly listed below and will be subject to amendment from time to time as required based on discussions with your manager:
• To check and validate all GAP claim documents received and to request any outstanding documents
• To follow the claims process and capture the claim information onto the system
• To verify and update any client personal information changes on the system policy record
• To assess the validity of the claim in accordance with the terms and conditions of the clients policy document and to make the relevant claim notes on the system
• To ensure a clients claim expectation is adequately addressed and managed by applying the TCF principals and effectively communicating with the client or broker regarding their claim
• To meet your daily minimum claim targets with a high level of accuracy and within service turnaround time
• To maintain and update your daily workflow tasks and queue
• To ensure high priority and escalated claims as identified by management are processed within 2 hours
• Interacting with medical aids, hospitals and medical practitioners regarding medical history and accounts required relevant to assessing the claim.
• Other administration related functions

• Good written and verbal communication skills
• Good negotiation skills and effective in dealing with customers and meeting their expectations
• Good understanding of how medical aids work and operate
• Ability to apply administration principals and work with detail and a high level of accuracy
• Intermediary MS Office, especially Excel, Word and Microsoft Outlook skills
• Good time management
• Planning and organising
• Works well in a team and independently
• Coping with pressure and setbacks
• Been pro-active and using your initiative