Administrator: IL Claims Assessment (Insurance)

Administrator: IL Claims Assessment

Location: Pretoria, South Africa

Salary: R19 800 – R22 000

Our client in the Insurance industry is looking for an Administrator: IL Claims Assessment.

Key responsibilities

1. Assessing and processing of life and funeral claims

• Process funeral and life claims and prepare for claims approval process within 48hrs of receipt
• Verify premiums paid on the system prior to assessing claims
• Verify deceased and beneficiaries against main policy on the system
• Confirm the policy holders relationship to the deceased
• Liaise with Re-insurers where necessary on Life cover policies below R300 000.00
• Refer suspicious fraudulent claims to Specialist administrator
• Discuss complex claims with in-house professional advisor and consultants
• Follow up timeously on all outstanding claims
• Liaise with relevant stakeholders on outstanding and incorrect Id numbers and where the person is covered on the application form but does not exist on the system
• Liaise with Client services where the deceased died before the policy become inactive. To activate the policy prior to assessing
• Responsible for identifying disputes and complaints of complex claims
• Recommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expires
• Update AIMS notes on system
• Be a 2nd validator on captured and authorized claims
• Give feedback on follow-up claims to Section leader 
• Forward a spread sheet of all finalized claims to Section Leader

2. Claims pay-out

• Confirm status of the claim if it is approved or declined
• Where the age of the deceased differ with the one on the system apply the penalty formula
• Recommend decline/payment of claims
• Double check the consistency on banking details attached to the claim and the one on the system
• Forward the claim to Manager for payment
• Check the finance list and sign off

3. Reconcile information received, processed and finalized

• Compile monthly individual statistics
• Compiling all branch registers month end (Death)
• Present challenges experienced and solutions taken to resolve them

Requirements           

• Matric
• NQF 4 in Insurance (Advantage)
• 2 years life insurance in claims
• Intermediate MS Office Word, Excel, PowerPoint

Send your CV and latest pay slip to hilda@aaaa.co.za

ATripleA Recruitment and Temps

www.aaaa.co.za