Senior Medical Claims Assessor
Bidvest Life Durban, KwaZulu-Natal, South Africa
Bidvest Life Durban, KwaZulu-Natal, South Africa
Bidvest Life Durban, KwaZulu-Natal, South Africa
1 week ago 114 applicants
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Job Purpose / Summary
To assess all income and disability claims (medical claims) in line with policy terms, company standards and claims philosophy
Job Content & Main Responsibilities
1. Assessment of all income and disability claims in line with policy terms and claims philosophy
- Review all documents submitted in terms of income protection, critical illness and permanent disability claims
- Formulate a decision on each claim
- Liaise with re-insurance partners as required
- Process payment on the claim
- Communicate the decision verbally and / or in written format to all parties
2.Case management
- Formulate a rehabilitation or case management plan on suitable cases to facilitate recovery and return to work
- Liaise with the claimant and rehabilitation specialists
3.Client relationships
- Communicate claim requirements to the relevant parties as required
- Communicate claims decisions to clients
- Communicate with claimants on their rehabilitation program
4.Support Medical Claims Assessors
- Assist Medical Claims Assessors with opinions on claims as required
- Review and sign-off decisions formulated by Medical Claims Assessors as required
Job Requirements
Minimum Qualifications
- Matric
- Tertiary qualification in Occupational Therapy, Physiotherapy, Biokinetics or Chiropractic
Minimum Experience
- 2 years of clinical experience advantageous
- 5 to 8 years of experience in the assessment of income protection and disability claims in the Long-Term insurance industry
- 2 years experience in managing a team
- Advanced computer literacy
Competencies
- Advanced understanding of medical conditions, treatment protocols and rehabilitation programmes
- Advanced understanding of functional impairment and how different medical conditions would affect ability to work
- Advanced analytical and problem-solving skills
- Attention to detail
- Excellent verbal and written communication skills
- Ability to manage conflict
- Ability to work under pressure at a fast pace
Occupational Level (choose one)
- Professionally Qualified and experienced specialists / mid-management: Professional knowledge of sub-discipline or discipline. Provide input in the formulation of Organisational/Functional Unit business plans. Formulate and implement departmental/team plans that will support the BU business plans. Optimization of resources (finances, people, material, information and technology) to achieve given objectives in most productive and cost-effective way.
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Employment type
Full-time
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