Job Title: Claims Assessor (Cape Town)

Job Description & Duties:
The duties briefly listed below will be subject to amendment from time to time as required based on discussions with your manager

• To check and validate all GAP claim documents received and to request any outstanding documents
• To follow the claims process and capture the claim information onto the system
• To verify and update any client personal information changes on the system policy record
• To assess the validity of the claim in accordance with the terms and conditions of the client’s policy document and to make the relevant claim notes on the system
• To ensure a clients claim expectation is adequately addressed and managed by applying the TCF principals and effectively communicating with the client or broker regarding their claim
• To meet your daily minimum claim targets with a high level of accuracy and within service turnaround time
• To maintain and update your daily workflow tasks and queue
• To ensure high priority and escalated claims as identified by management are processed within 2 hours
• Interacting with medical aids, hospitals and medical practitioners regarding medical history and accounts required relevant to assessing the claim.
• Other administration related functions

Skills:
• Good written and verbal communication skills
• Good negotiation skills and effective in dealing with customers and meeting their expectations
• Good understanding of how medical aids work and operate
• Ability to apply administration principals and work with detail and a high level of accuracy
• Intermediary MS Office, especially Excel, Word and Microsoft Outlook skills
• Good time management
• Planning and organizing
• Works well in a team and independently
• Coping with pressure and setbacks
• Been pro-active and using your initiative

Attitude:
•Ability to work well under pressure
•Commitment to meet daily targets
•Self-motivated
•Having a can-do attitude
•Willingness to always assist clients with their claims and requirements
• Actual Medical Aid claims processing and administration experience
• Insurance industry experience