South Africa

Administrator: IL Claims Assessment

Company Assupol Life
Reference # AICA
Published 18/02/2020
Contract Type Permanent
Location Menlyn, Gauteng, South Africa
To assess Funeral and Life cover claims below R300 000
Job Functions Administration
Industries Insurance
Duties & 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 finalised
• Compile monthly individual statistics
• Compiling all branch registers month end (Death)
• Present challenges experienced and solutions taken to resolve them
1. Formal Education
• Matric

2. Technical/Legal Certification
• NQF 4 in Insurance (Advantage)

3. Experience
• 2 years life insurance

4. Knowledge
• Legislation
• Life Insurance Industry
• Long Term Insurance Claims

5. Skills
• Computer Literacy
• Communication
• Analytical
• Problem Solving
• Interpersonal

6. Attributes
• Assertiveness
• Team Player
• Attention to detail
• Planning & Organizing
• Control Procedures
Job Closing Date 06/03/2020
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Last Updated: 13-2-2020 []
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