Discovery Limited: Claims and Underwriting Administrator

Job Description:

Discovery Limited is looking to employ a Claims and Underwriting Administrator.

Location: Johannesburg

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Duties And Responsibilities

  • Principle Accountabilities
    Compile a report for brokers from SFE and Compass, send medicals requirements requests to brokers/SC in order to be completed by member for underwriting members’ over the acceptable limit.
    Link the received completed medicals to the system and allocate to the underwriters for a decision.
    Send completed medicals to another insurer on request and/or request completed medicals from other insurer to underwrite member.
    Load members on the system to the smart service team for a nurse to complete required medical documents.
    Access completed medicals from the Smart Service System if not already on SFE.
    Link the received completed medicals to the system and allocate to the underwriters for a decision.
    Verify the membership on Paradigm, that covers are aligned on SFE and Compass. Ensure member is on SFE.
    Ensure all documents submitted are correct and completed in full. Where documents are missing, source the documents from Meditech or other Pathologists.
    Once all documentation is attached on SFE, complete audit for Member and move it to the Underwriters.
    Investigate reasons for anomalies on any underwriting admin process and troubleshoot. Look out for members that need decisions to be re-applied.
    Receive claims from Indexing department for assessment of the funeral and death claims – member; child or spouse claims as well as extended family members. Assess each claim by verifying claim details against standard claims requirements.
    Liaise with Broker should documentation not be in order. Should discrepancies be picked up, refer the documentation to the Forensics Department and ensure regular follow-up until Forensics provide an investigation outcome.
    Once all documentation has been received, set up payment on the system for verification by second Assessor and Authoriser. Receive claims for verification (second assessing) and authorizing.
    Issue payment letters and/or claims decision letters to Brokers once payment has been approved
    Process disability claims (CD, ICB and SIB claims), acknowledge receipt and process accordingly
    Correspond with the brokers and members when we receive queries relating to their claims
    Ensure that claims are allocated to the assessor for further assessments
    Lead the process in ensuring that reminders, close case and suspensions are communicated efficiently and timeously
    Personal Attributes and Skills
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The successful candidate must demonstrate the following competencies:

1. Priority Setting

2. Time Management

3. Written Communication

4. Creativity

5. Work/Life Balance

6. Drive for results

7. Flexibility and adapting to change

8. Consistency whether under pressure or normal workload

ALSO APPLY FOR   ULTCARE: Personal Assistant

Qualifications And Experience

  • Education and Experience
    Matric – essential.
    Relevant Industry Qualifications – Advantageous
    Microsoft Office skills, i.e. Outlook, Excel and Word are mandatory.
    Minimum 1 year’s working Employee Benefits-Group Risk claims experience.
    Knowledge of Group Risk Industry benefit usage and payments.
ALSO APPLY FOR   Administration Clerk 

How To Apply:

Click Here To Apply…

Closing Date : 28 February 2022

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