Claims Assessor

Guardrisk; Sandton; On-site; ZAR 300,000 - 480,000; Full time

Job summary

A leading insurance company is seeking a Claims Manager to handle 3rd party claims, ensuring efficient processing and assessment. The ideal candidate will have at least 3-5 years of claims handling experience and relevant insurance background. This role involves preparing reports, managing communications, and contributing to the claims business unit while promoting excellent service delivery.

Qualifications

• Minimum 3-5 years of claims handling experience.
• Relevant insurance experience required.
• Medical and underwriting background advantageous.

Responsibilities

• Manage 3rd party claims and coordinate swift claims processing.
• Prepare monthly reports and respond to emails within 24 hours.
• Assess claims and provide professional service to clients.

Skills

Accountability for service delivery

Time management

Self-motivation

Collaboration

Problem-solving skills

Excellent verbal communication skills

Excellent written communication skills

Complaints management

Education

Matric / Grade 12

Tools

Word

Excel

Outlook

Job description

Role Purpose

Full responsibility for 3rd party claims, including end-to-end assessment, decision making, reporting, analysis, and feedback to Life Operations and Capitec Operations Executives. Additionally, responsible for other claims with similar end-to-end processes.

Requirements

• Matric / Grade 12
• Relevant Insurance Experience
• Claims-related experience advantageous
• Medical background advantageous
• Underwriting background advantageous
• At least 3-5 years claims handling experience

Duties & Responsibilities

• Manage 3rd party claims (Non-mandated intermediaries)
• Coordinate and perform full assessment to ensure swift claims processing
• Support the life claims business unit
• Respond to all emails within 24 hours
• Capture claims onto the Claims System
• Provide feedback to the life claims team and relevant binder holders
• Prepare monthly reports
• Escalate complex claims to the Claims Committee
• Handle complaints professionally
• Maintain knowledge of claims business practices and procedures
• Understand cell captive information for correct client claim capture
• Follow up with relevant parties for administration and query resolution
• Understand technical medical terminology
• Access and integrate information quickly
• Apply Rule 17 of the PPRs and promote TCF outcomes
• Interpret policy wording accurately
• Apply Rule 18 of the PPRs
• Deliver professional and efficient service
• Promote TCF / PPR outcomes
• Stay updated on Guardrisk developments
• Handle extraordinary cases appropriately
• Coordinate resolution processes and liaise with other business units as needed
• Gather information to finalize claim capturing
• Assess all third-party claims and claims landing in the inbox
• Analyze data for trend identification and feedback
• Assist with ad-hoc projects and record-keeping
• Respond to complaints and perform root cause analysis

Competencies

• Accountability for service delivery
• Time management
• Self-motivation
• Collaboration
• Living the company values
• Discipline
• Teamwork
• Proficiency in Word, Excel, Outlook
• Problem-solving skills
• Organizational skills
• Excellent verbal and written communication skills
• Complaints management