Senior Assessor: IL Claims

Assupol Life

Gauteng, South Africa

Permanent

Aug 30

To validate and asses all death claims, ill health and disability claims 1.Assessing and processing of life claimsCapture and process life claims below R300 000 cover (Retirement annuities, 4sure policies, Endowment) Update notes on systemVerify premiums paid on the system prior to assessing claimsVerify deceased and beneficiaries against main policy on the systemConfirm the policy holders relationship to the deceasedRefer suspicious fraudulent claims to admin supportDiscuss complex claims with in-house professional advisor and consultantsFollow up timeously on all outstanding claimsLiaise 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 systemLiaise with Re-insurers where necessaryFollow up timeously on all outstanding claimsRecommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expiresRecommend for decline/payment of claimsLiaise with admin support on all the suspicious claimsLiaise with admin support on all ITC and tracing enquiriesMonitor and report trends to manager2.Assessing funeral claimsProcess funeral claims and prepare for claims approval process within 48hrs of receiptVerify premiums paid on the system prior to assessing claimsVerify deceased and beneficiaries against main policy on the systemConfirm the policy holders relationship to the deceasedRefer suspicious fraudulent claims to admin supportDiscuss complex claims with in-house professional advisor and consultantsFollow up timeously on all outstanding claimsLiaise 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 systemLiaise with Client services where the deceased died before the policy become inactive. To activate the policy prior to assessingResponsible for identifying disputes and complaints of complex claimsRecommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expiresUpdate AIMS notes on systemOversee funeral claims assessed by claims assessors as 2nd validators3.Claims pay-outConfirm status of the claim if it is approved or declinedWhere the age of the deceased differ with the one on the system apply the penalty formulaRecommend decline/payment of claimsDouble check the consistency on banking details attached to the claim and the one on the systemForward the claim to Manager for paymentCheck the finance list and sign off4.Recommendation of complex claims Identifying disputes and complaints of complex claims (Life policies below R300 000) Recommend a solution to Senior Manager5.Reconcile information received, processed and finalisedCompile monthly individual statisticsCompile reports as requested by managers (for audit purposes)Compiling all branch registers month end (Death and Rider benefit claims)

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