Reference Number MMH240719-6
Job Title Life Disability Claims Specialist
Position Type Permanent
Role Family Client Services
Cluster Guardrisk
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Sandton
Introduction
Responsible for the day to day management and processing of the Life 1 st & 3 rd Party Claims.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose
Responsible for the day to day management and processing of the Life 1 st & 3 rd Party Claims.
Requirements
- Matric Certificate
- BCom Degree would be an added advantage
- Previous management (junior/senior) in a Claims Department
- Preference given to candidates who have previously worked in an EB environment with a minimum of 3 years
- Working knowledge of Reinsurance claims systems
- Working knowledge of all MS Office Applications
- Prior handling and exposure to any type of 1 st party product
- At least 5 years claims management experience
- At least 10 years insurance industry experience
- At least 3 years policy wording interpretation experience
- Provide coaching, support, and assistance to claims staff (1 st & 3 rd Party claims staff)
- Assessment and Management of all PTD Lump Sum, PHI, TTD, GLA, Hospital, Retrenchments, Critical Illness/Dread Disease & Funeral
- Assessment and Management of all Dread Disease, PHI and TTD, PTD Lump Sum payment calculations
- Attend monthly client meetings where applicable
- Ad hoc projects ( System enhancements etc )
- Attending to complex 1 st & 3 rd Party matters
- Ensuring regulatory requirements are adhered to
- Performing claims reviews when required
- Claims sampling on 1 st Party claims
- Providing guidance and feedback on complex claims and ensuring fair and equitable decisions are made
- Dealing with applicable Reinsurer on complex claims
- Dealing with clients on referrals
- Making recommendations of changes to policy terms for any client
- To assist with 3 rd party claims processing, assessment & management when required by management
- Oversee and perform claim review processes with the focus on mitigating risk exposures to Guardrisk and ensuring overall compliance with regulatory requirements
- The facilitation of identification of gaps/trends or exceptions and escalate to cell captive/binder holder/ PM. Document actions to identify gaps
- Manage and assist, where required with the drafting and presentation of monthly team reports
- To provide ongoing guidance to claims staff on technical aspects
- Maintain and develop new and existing working relationships with internal and external stakeholders
- Understanding Rule 17 of the PPRs and the TCF framework and the impact it has on day-to-day functions within the business unit
- Management of an effective 1 st & 3 rd party claims environment
- Continually review internal workflow processes to improve service delivery
- Ensuring that fair and equitable decisions are made on all 1 st party claims
- Effective management of complex matters and providing guidance and/or instruction to cell captives/binder holders
- Dealing directly with applicable Reinsurers and relevant stakeholders in the decision-making process, the handling of complex matter and dealing with referrals
- To assist with 3 rd party claims management when required by management
- Responsible for the capturing of all claims onto the Cell/Binder Source system and or GR Cell Administration system (Neo)
- Attending to ad-hoc tasks/Projects when required
- PC skills, including experience in using software for producing presentations, spreadsheets, and project planning
- Project management
- Ability to interact with all levels including executives and directors
- Strong interpersonal, presentation, analytical and review/audit skills
- Excellent organizational skills and the ability to prioritize multiple tasks and projects using effective time management skills
- Strong written and verbal communication skills
