Full responsibility for 3rd party claims, end-to-end assessing and decision making, reporting, analysis and feedback to Life Ops and Capitec Ops Executives. Full responsibility for other claims, end-to-end assessing and decision making.
Requirements
- Matric /Grade 12
- Relevant Insurance Experience
- Claims related experience advantageous
- Medical background advantagous
- Underwriting background advantageous
- At least 3- 5 years claims handling
- Being responsible for 3rd party claims (Non-mandated intermediaries)
- Co-ordinates and performs the full assessment function in ensuring that all claims are dealt with swiftly
- Role serves as direct support for the life claims business unit
- Ensuring all emails are dealt with within 24 hours
- All claims to be captured onto the Claims System
- Feedback to be provided to life claims team
- Feedback to be provided to relevant binder holders
- Monthly reporting to be provided
- Escalation of complex claims to the Claims Committee
- Handling of complaints
- Knowledge of the business practices and procedures of Claims.
- Knowledge of cell captive information so the claim is captured under the correct client details
- Being aware of whom to follow up with for speedy administration and query resolution
- Understanding of technical medical terminology
- The ability to access and integrate information quickly
- Application of Rule 17 of the PPRs and the TCF Outcomes
- Application of sound claims processes and interpretation of policy wording
- Application of Rule 18 of the PPRs
- Professional and efficient service level delivery
- Promote TCF / PPR outcomes
- Keeping abreast of developments within Guardrisk
- Handling of extraordinary cases/ situations
- Responsible for point of contact resolution process for the business and liaising with other business units where necessary to finalize capturing of customer requests/complaints
- Gathering of required information in order to finalise capturing requirements
- Assessing all 3rd party claims
- Assessing claims landing in the Life Claims inbox
- Performing analysis on data for trend identification and feedback
- Assistance with ad-hoc projects from time to time
- Assistance with filing and record-keeping
- Responding to complaints
- Performing Root Cause Analysis on complaints
