Administrator_IL Claims Assessment (Hospital Cashbacks)

Administrator_IL Claims Assessment (Hospital Cashbacks)

Apply
Insurance, Gauteng Tshwane (Pretoria)
R 23818

Claims Assessment Administrator with Hospital Cashback Plans Experience_Permanent position for our well established and reputable long term life insurance client situated in Pretoria



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 the 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


Apply Here http://bit.ly/2PlrfE1

Job id : , #69962, 55 views,

« SECRETARY TO THE OFFICE MANAGERAdministration and Logistics Coordinator »