Risk Claims Assessor

2 days ago


Johannesburg, Gauteng, Saudi Arabia FirstRand Group Full time

Job Description

Accurate assessment, investigation and management of long-term insurance claims in accordance with the goals, objectives, processes and standards of the organization to meet customer expectations.

  • Accurate assessment, investigation and management of long-term insurance claims including Health hospital Cash claims and critical illness claims.
  • Ensuring that the claims assessment and that the standard of decision is consistent with the company values and philosophy.
  • Ensuring all risks are mitigated and escalated, this includes the identification of fraudulent activity, policy abuse and pre-existing conditions.
  • Providing effective, efficient and professional service to all our customers, advisors and branches, both telephonically and through written correspondence.
  • Taking ownership of queries and ensuring they are resolved timeously and effectively.
  • Ensuring adherence to organisational best practice and legislative requirements.
  • Teamwork to meet service and quality standards.
  • Deliver exceptional service that exceeds customers' expectations through proactive, innovative and appropriate solutions.

Additional Requirements

  • At least 2 years' medical claims assessment experience
  • Worked with hospitalisation or similar claims
  • Worked in a Long-term insurance environment
  • Experience in dealing with Ombudsman / escalated queries

Qualifications and Experience

  • Minimum: Matric
  • Nursing background will be advantageous

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