Medical Claims Assessor, Umhlanga
R20 000 – R30 000 CTC
JOB PURPOSE
The purpose of the role is to assess income,
disability and critical illness claims following
policy terms and claims philosophy as well as
facilitate case management programmes where
applicable to assist claimants in their return to
work journey.
KEY PERFORMANCE AREAS
DUTIES
Assessment of all claims in line with policy terms, company
standards and claims philosophy, including temporary and
permanent disability and critical illness claims.
Communicating claims decisions in an accurate, structured and
clear manner to clients (verbal and written).
Proactive engagement with clients to improve the claim
assessment and management process.
Implementing case management plans to ensure maximum
medical improvement and facilitate return to work.
ACADEMIC QUALIFICATION/S AND
KNOWLEDGE REQUIRED
Matric and a tertiary qualification in Occupational
Therapy/Physiotherapy/Biokineticist/Chiro.
Advanced understanding of medical conditions, treatment
protocols and rehabilitation programs.
Advanced understanding of functional impairment and how
different medical conditions would affect ability to work.
EXPERIENCE REQUIRED
(YEARS & TYPE)
Minimum 2 years clinical work experience advantageous
Experience in the long-term insurance industry would
be advantageous
STAFFING REQUIREMENTS;
CORE COMPETENCIES AND
BEHAVIOURAL COMPETENCIES
Advanced understanding of medical conditions, treatment
protocols and rehabilitation programs
Advanced analytical and problem-solving skills
Attention to detail
Excellent verbal and written communication skills in English
Confidence and composure in handling difficult situations and
manage conflict while remaining empathetic
Ability to learn quickly and understand technical product
concepts
Excellent computer skills
Ability to work under pressure at a fast pace
Willingness to take ownership and responsibility
Coaching and leadership capabilities
Passion for team work and client servicing
Advert Posted by Nicky of Pro Talent recruitment
Send your CV to nicky@proappoint.co.za
