Assupol Life: Senior Assessor








Company Assupol Life
Reference # SA
Published 30/08/2021
Contract Type Permanent
Salary Market Related
Location Menlyn, Gauteng, South Africa
Introduction
To validate and asses all death claims, ill health and disability claims
Job Functions Administration
Industries Insurance
Specification
1.Assessing and processing of life claims
•Capture and process life claims below R300 000 cover (Retirement annuities, 4sure policies, Endowment)
•Update notes on system
•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
•Refer suspicious fraudulent claims to admin support
•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 Re-insurers where necessary
•Follow up timeously on all outstanding claims
•Recommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expires
•Recommend for decline/payment of claims
•Liaise with admin support on all the suspicious claims
•Liaise with admin support on all ITC and tracing enquiries
•Monitor and report trends to manager
2.Assessing funeral claims
•Process funeral 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
•Refer suspicious fraudulent claims to admin support
•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 AIMS notes on system
•Oversee funeral claims assessed by claims assessors as 2nd validators
3.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
4.Recommendation of complex claims
•Identifying disputes and complaints of complex claims (Life policies below R300 000)
•Recommend a solution to Senior Manager
5.Reconcile information received, processed and finalised
•Compile monthly individual statistics
•Compile reports as requested by managers (for audit purposes)
•Compiling all branch registers month end (Death and Rider benefit claims)





Requirements
FORMAL EDUCATION
•Diploma: Business Administration/3 years or longer relevant qualification
•Health background (Advantage)

TECHNICAL/LEGAL CERTIFICATION
•FAIS, FICA, LTIA, Medical Terminology and understanding

EXPERIENCE
•3-5 years claims assessment

Job Closing Date 13/09/2021