Key Performance Areas

Pre-Assessment of prospective claims

• Record all the submitted documents for prospective claims.
• Determine the benefits and the products submitted based on the submitted documents.
• Assess the submitted documents to determine compliance as per defined processes and rules.
• Apply compliance and/ lodgement rules in pre assesing the prospective claim.
• Identify duplicate claims and linked claims.
• Examine the prescription of lodgement and apply prescription rules.
• Verify mortality with Home Affairs
• Communicate the assessment outcomes to the prospective claimants

Quality assurance

• Ensure that pre assessment processes are implemented and maintained at the highest standards
• Maintain the implementation an unusual occurrence procedures.

Administrative support

• Document the acknowledged claims.
• Deal with/and respond to correspondence.
• Produce documents, briefing papers, reports and presentations.
• Assist with typing and editing briefs, technical papers, letters to various parties, and memos.

Reporting

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives

Stakeholder management

• Maintain healthy relationships with all stakeholders.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• Respond to queries within the predefined turnaround times

Qualifications and Experience  

• Bachelor’s Degree/Advanced Diploma in a related qualification
• Relevant 3 years’ experience in the Claims environment.