Claims Assessor

AtripleA recruitment & temps

Cape Town

On-site

ZAR 180,000 - 240,000

Full time

14 days+

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Job summary

A recruitment agency is seeking a Claims Assessor in Cape Town. The role focuses on checking and validating GAP claim documents, following processes, and managing client expectations. Candidates should have strong communication and negotiation skills, familiarity with medical aids, and prior experience in claims processing. This position offers the chance to utilize your attention to detail and work both independently and in a team environment. To apply, submit your CV and latest payslip.

Qualifications

Good understanding of medical aid operations.
Ability to maintain high accuracy in processing claims.
Proven experience in administration and claims processing.
High attention to detail with the ability to work accurately.
Proficient in MS Office, especially Excel, Word and Outlook.
Good time management and planning skills.
Ability to work well in a team and independently.
Capable of handling pressure and meeting targets.

Responsibilities

Check and validate all GAP claim documents.
Follow the claims process and update system records.
Verify claim validity according to client policy terms.
Manage client expectations and communication.
To ensure client claim expectations are addressed and communicated with client/broker.
To meet daily claim targets with accuracy within service turnaround time.
To maintain and update daily workflow tasks and queues.
To manage high priority/ escalated claims and process within 2 hours.
To liaise with medical aids, hospitals and practitioners regarding medical history and accounts.
To perform other administration related functions.

Skills

Good written and verbal communication skills

Good negotiation skills

Understanding of how medical aids work

Intermediary MS Office skills

Good time management

Planning and organising

Works well in a team

Ability to cope with pressure

Tools

MS Office

Job description

Job Title: Claims Assessor (Cape Town)

Job Description & Duties

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 client's 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

Skills

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

Attitude