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Risk Claims Assessor
2 days ago
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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