Claims Evaluation Specialist

Bebeeassessment; Johannesburg; On-site; ZAR 300 000 - 450 000; Full time

Job summary

A claims assessment company in Johannesburg is seeking a Life Claims Assessor to ensure accurate assessment and communication of claims. The role requires 3-5 years of experience in life claims assessment and a solid educational background in health-related fields. Candidates must demonstrate strong professional communication and the ability to independently assess claims while adhering to service levels. This role is vital in maintaining high-quality assurance standards and requires presenting complex claims for verification.

Qualifications

• 3-5 years in Life Claims Assessment (Death, Disability, Severe Illness).
• 2-3 years in Underwriting roles.
• Prior knowledge of risk management and medical terminology is advantageous.

Responsibilities

• Accurately assess and communicate claims in adherence with rules.
• Evaluate an average of 7 benefits per day.
• Assess claims independently within established authority limits.
• Maintain a disciplined approach to service levels.
• Achieve Quality Assurance score above 85% consistently.
• Present complex claims to internal committees.

Skills

Professional communication

Knowledge of medical terminology

Risk management

Education

Matric + Diploma / bachelor's degree in health-related field

Job description

Life Claims Assessor

To guarantee that claims are accurately assessed and communicated effectively, in accordance with business rules and service level agreements.

Average of 7 benefits per day evaluated.

Professional communication required at all times.

Independently assess claims within established authority limits.

Maintain a disciplined approach to service levels.

Quality Assurance score above 85% achieved consistently.

Present complex claims to internal committees for verification purposes.

Required qualifications : Work Experience :

3-5 years in Life Claims Assessment (Death, Disability, Severe Illness).

2-3 years in Underwriting roles.

Education :

Matric + Diploma / bachelor's degree in a health-related field (Nursing, Occupational Therapy, Physiotherapy) or equivalent experience.

Prior knowledge of risk management and medical terminology is advantageous.