Gap Claims assessor

Measured Ability; Wes-Kaap; On-site; ZAR 200 000 - 300 000; Full time

Job summary

An established industry player is seeking a Claims Assessor who will play a vital role in validating and processing GAP claims. This position requires a strong understanding of medical aid operations and insurance policy administration. The successful candidate will be responsible for ensuring claims are processed accurately and efficiently, while also managing client expectations through effective communication. Initially working from the office during a 3-month probation period, the role may transition to a hybrid model based on performance and connectivity. This is a fantastic opportunity to grow within a dynamic environment and make a meaningful impact in the insurance sector.

Qualifications

• Thorough understanding of medical aid operations or insurance policies.
• Matric is a requirement for this position.

Responsibilities

• Validate GAP claim documents and request outstanding information.
• Follow claims process and capture information into the system.
• Ensure high priority claims are processed within 2 hours.

Skills

Understanding of medical aid operations

Insurance policy administration

Education

Matric

Job description

• Applicants must have a thorough understanding of medical aid operations or insurance policy administration and operations.
• Matric.

Responsibilities:

1. To check and validate all GAP claim documents received and to request any outstanding documents.
2. To follow the claims process and capture the claim information into the system.
3. To verify and update any client personal information changes on the system policy record.
4. To assess the validity of the claim following the terms and conditions of the clients' policy document and to make the relevant claim notes on the system.
5. To ensure a client's claim expectation is adequately addressed and managed by applying the principles and effectively communicating with the client or broker regarding their claim.
6. To meet your daily minimum claim targets with a high level of accuracy and within service turnaround time.
7. To maintain and update your daily workflow tasks and queue.
8. To ensure high priority and escalated claims as identified by management are processed within 2 hours.
9. Interacting with medical aids, hospitals and medical practitioners regarding medical history and accounts required relevant to assessing the claim.
10. Other administration-related functions.

Salary: R16 000 - R19 000

Disclaimer:

The successful applicant will be working from the office for the initial probation period of 3 months, and the position may become hybrid depending on the internet connectivity of the successful candidate.

Kindly note that the first 3 months of probation and training will be done within our Client Contact Centre for all successful candidates. The successful candidate will then be assigned to their relevant department based on the company’s requirements and the individual’s progress and skills. This would mean that even though a successful candidate may have applied for the Claims Assessor position, they will still have their probation and training within the Client Contact Centre and may only be transferred to the Claims Assessing department based on the company’s needs and the person’s progress and skills gained within the Client Contact Centre.