Claims Assessor Specialist

Discovery Limited · Johannesburg, Gauteng

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Key Purpose

Responsible for assisting claims specialists, assessors as support services for claims investigations.
More specifically assisting the assessing, legal and medical team with the investigation of claims/underwriting discrepancies, obtaining evidence in order to adjudicate death, disability and severe illness claims. Collection of claims requirements, uploading and characterising of evidence, interpreting data and researching in general.

Areas of responsibility may include but not limited to

To ensure the claims department is provided with properly investigated cases that will enable assessors to assess the claim and pay valid claims
Gathering of claims related requirements, evidence, records from various third parties.
Support services for claims, claims escalations, reviews and Ombudsman queries to ensure high quality and proficient claims assessment
Identify claims that pose a potential risk to the business in general
Identify possible training opportunities/ information sharing that will assist the teams to detect high risk claims.
Participating in real time liaison with government departments, industry forums on strategy of designing and implementation of tools/strategic initiatives to identify high risk claims
Ad hoc covert and humit surveillance operations.
In service training regarding modern key skills in the investigation and prevention

Competencies

Technical Skills and Knowledge

Essential

Data Analysis
Ability to communicate with the public, government officials in general and claims assessors at all levels
Testify in court or other tribunals

Qualifications & Experience