Claims Consultant

About the position

Position duties:

• Evaluate claims forms and supporting documentation in preparation of making an payment decision
• Gathering information and various types of reports from medical practitioners
• Compare the reports to our existing claims criteria to establish if claim is payable
• Decide on levels of provisions to be raised based on information received
• Writing claims assessment standards/policies
• Auditing/QA of work done by peers
• Deliver claims payment decision
• Determine requirements / documents required to evaluate claims
• Liase with relevant re-insurers to determine validity of claims and get their approvals where required
• Explain and communicate final decisions to brokers and clients
• Create schedules for payments and obtain relevant approvals

Position requirements:

• Minimum 2-3 years experience in Life Insurance Assessing
• Medical Background
• Experience in both group and life individual life claims (Essential)
• Sound Business and Operational knowledge of Insurance Industry administrative processes
• Good knowledge of the business administration platforms
• Familiar with Compliance Processes and Procedures in the Insurance Industry
• Familiar with the business products and their rules and workings
• Familiar with the business products and their rules and workings

 

Desired Skills:

• Auditing
• Claims
• Life Insurance