RESPONSIBILITIES:

• Review, analyze and approve death and major claims within authority limits.
• Corresponds with internal departments, agents, medical providers, and others as required to gather necessary information to solve complex cases and summarize findings and recommended actions.
• Ensure compliance by following laws and regulations, internal control requirements and the Claims policy.
• Ensure the effective assessment of claims through effective investigation and assessment in line with Company policies and required turnaround times.
• Liaise with clients and financial advisors when necessary, with empathy, care and factually correct information.
• Escalations of claims should be done in an appropriate and timeous manner.
• Effective reporting of claims through the correct collection of documentation; accurate capturing and checking of data; and confirmation of payment details and amounts all within the required SLA.
• All Internal and External communication (written and verbal) is done in a professional manner an in-line company policy.
• Accurate sending of decision letters within agreed time frames and to escalate enquiries where relevant.
• Drive continuous improvement within the department to streamline and improve on processes; way of work; quality or efficiency of work.
• Take ownership and accountability of all queries and ensure that they are resolved timeously and effectively.
• Build and maintain relationships with brokers, clients and all other stakeholders, to ensure service excellence.

QUALIFICATIONS:

• Bachelor’s degree in medical background field or legal
• Minimum 2 years exposure to claims assessor experience (Use to perform death or major claims is advantage)
• Momentum product knowledge, insurance industry knowledge, claims process knowledge preferred.