Guardrisk
Claims Assessor
Sandton
Introduction
Are you passionate about delivering exceptional client experiences and thrive in a detail-oriented environment? We’re looking for a dynamic Claims Assessor to join our team and help ensure a smooth, accurate, and seamless Gap Cover claims process for our members.
If you’re experienced in the health or short-term insurance space, confident in your decision-making, and ready to make a real impact in a fast-paced environment, this could be the perfect next step in your career. Join us and be part of a team that values service excellence, problem-solving, and client-centricity.
Disclaimer
As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose
To process medical expense shortfall (Gap cover) claims in accordance with stipulated service levels and policy conditions.
Requirements
- Matric
- Computer literacy
- FAIS FIT and proper, including RE5
- At least 2 years of experience in short-term or medical health and accident insurance handling.
- At least 2 years of client service experience.
- Good knowledge of the local health industry, including the application of ICD-10 and BHF tariff codes
- Knowledge of the OWLS system is advantageous.
Duties & Responsibilities
- Coordinate gap cover claims received from contracted medical schemes to ensure a seamless claims experience for mutual customers.
- Address client and broker queries within the stipulated time frame.
- Ensure all registered claims are assessed and administered effectively and efficiently in accordance with relevant legislation and policy wording.
- Communicate with relevant medical schemes via email or telephone regarding outstanding documentation.
- Accurately and completely capture clinical details in the OWLS claims administration system.
- Monitor system communications related to claims to keep customers and brokers updated on the claims process.
Competencies
- Results and solution-driven
- Strong focus on client centricity and service excellence
- Strong problem-solving and decision-making capabilities
- Analytical with attention to detail
- Resilience and ability to work under pressure
- Effective communication skills and professional client management
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