Talent Pool Claims Assessor

Pivot Services; Centurion; On-site; ZAR 240,000 - 360,000; Full time

Job summary

Pivot Services is seeking a claims assessor to evaluate, review and manage disability, dread disease and income disability claims in line with service levels and company policy. The role requires coordinating with stakeholders to improve the claims experience and maintain accurate records in accordance with relevant legislation.

The ideal candidate will have 1–2 years of claims processing experience and a relevant degree or an equivalent qualification. Grade 12 is essential.

Qualifications

• Desirable relevant degree or qualification in a field related to claims.
• Grade 12 or equivalent qualification is essential.
• 1-2 years experience in processing claims.
• Experience in assessing insurance or medical aid claims, paper and/or EDI preferred.

Responsibilities

• Assess, review and manage disability, dread disease and income disability claims in line with SLAs and policy.
• Partner with stakeholders to improve claims assessment and client experience.
• Advise on and contribute to development of procedures within area of specialisation for quality and service improvement.
• Keep accurate records of all claims assessed per legislation and policy.
• Stay informed on regulatory frameworks and court decisions that could impact claims.
• Assist with continuous improvement to reduce costs and improve quality of decisions and systems.
• Provide testing support for claims systems as part of development and maintenance.

Education

Relevant degree or qualification (Desirable).

Grade 12 or equivalent qualification (Essential).

Job description

About the Role

The successful incumbent will be responsible for assessing, reviewing, and managing living benefit claims in accordance with relevant legislation and company policy, while adhering to Service Level Agreements and meeting client and business expectations.

Key Responsibilities

• INTERNAL PROCESS - Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level... - Partner and collaborate with relevant stakeholders, to improve claims assessment and the client's claim experience. - Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement. - Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation. - Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the... - Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhance... - Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.

Qualifications and Experience

• QUALIFICANTIONS - Relevant degree or qualification (Desirable). - Grade 12 or equivalent qualification (Essential). - EXPERIENCE - 1-2 years experience in processing claims. - Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (Desirable).
• years experience in processing claims. - Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (Desirable).