Claims Assessor

Rand Mutual - Rma; Cape Town; On-site; ZAR 300 000 - 400 000; Full time

Job summary

A leading insurance company in Cape Town is seeking a Claims Assessor to manage and adjudicate claims efficiently. The ideal candidate will have a FAIS Regulatory Examination (RE5) and an NQF Level 5 qualification, along with 3 to 5 years of claims experience. Key duties include processing claims accurately, managing customer inquiries, and collaborating with colleagues to ensure high-quality service. Competitive salary package offered.

Qualifications

• 3 to 5 years claims related experience.
• Intimate knowledge of the COID Act.
• Knowledge of Claims processing, approval, Insurance and/or Medical Aid experience.

Responsibilities

• Adjudicate and process claims effectively.
• Manage claims in line with individual targets.
• Communicate claims process to employers and employees.

Skills

Good Administrative skills

Advanced Excel Skills

Deadline driven

Education

FAIS Regulatory Examination (RE5)

NQF Level 5 Higher Certificate in a FAIS Recognised Qualification

Job description

Job Description

THE JOB AT A GLANCE As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor.

What will you do?

You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. Claims Adjudication : Verify claims captured for correctness and compliance. Capture / accept additional information on claims i.e. medical reports. Ensure all documents required to process a claim are indexed and filed into the system. Add meaningful and accurate notes to ensure complete synopsis of claim on the system. Update requirements on claims and ensure they are always accurate and up to date. Claims Management: Manage claims in line with individual targets. Review of claims in line with process, authority limits and within agreed timelines. Escalate where required within authority limits. Management of medical reports for claims with Permanent Disability. Communicate claims process to both the employer and employee as set out in the claim's management processes. Timely management of workflows and notifications. Adjudicate and process payments for claims: Adjudication and processing of TTD benefits including approval within authority limits. Adjudicating and processing payment of sundry invoices within authority limits. Process Permanent Disability claims. Customer Service: Regularly communicate and liaise verbally and in writing with customers / suppliers / visitors / enquirers and relevant staff. Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions. Manage walk-in queries as and when required in line with the RMA Service Catalogue. Handle customer inquiries both telephonically and by email. Research required information using available resources. Provide customers with accurate product and service information in an efficient manner. Update existing customer personal information on the system. Deal with all customers in a professional and empathetic manner.

What will you get in return?

We offer great opportunities for personal and professional development in a stable company that is years strong.

The role comes with a competitive salary package and various benefits.

Furthermore, you will be part of a dedicated group of colleagues who value teamwork and collaboration.

Turnaround time The shortlisting process will only start once the advert due date has been reached. The time taken to complete this process will depend on how far you progress within the recruitment process and the availability of our managers.

Our Commitment to transformation

In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.

Job Requirements

• FAIS Regulatory Examination (RE5) (Essential)
• NQF Level 5 Higher Certificate in a FAIS Recognised Qualification (Essential)
• A medical qualification (Advantageous)
• 3 to 5 years claims related experience (Essential)
• Intimate knowledge of the COID Act
• Good Administrative skills
• Advanced Excel Skills
• Knowledge of Claims processing, approval, Insurance and / or Medical Aid experience
• Deadline driven

Kindly note that should you not receive a response within 21 days, please consider your application unsuccessful.

Closing date

16th November