Claims Consultant

Youll be based at our head office in Sandton, Johannesburg. Youll report to the Team Leader:
Claims

Assessing responsible for Claims.

Relevant tertiary qualification; a medical degree preferable

• 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 reorts to our exisitng 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
• Determine requirments / 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

• 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