Pretoria: Administrator posted by AtripleA recruitment & temps

About the Role

Our client in the Insurance industry is seeking an experienced Administrator to join their team, specifically handling IL Claims Assessment. The ideal candidate will be responsible for processing and assessing life and funeral claims, ensuring timely and accurate payment.

Key Responsibilities

• Assessing and processing of life and funeral claims within 48 hours of receipt

• Process funeral and life claims and prepare for claims approval process

• Verify premiums paid on the system prior to assessing claims

• Verify deceased and beneficiaries against main policy on the system

• Confirm the policy holder’s relationship to the deceased

• Liaise with Re-insurers where necessary on Life cover policies below R300 000.00

• Refer suspicious fraudulent claims to Specialist administrator

• Discuss complex claims with in-house professional advisor and consultants

• Follow up timeously on all outstanding claims

• Liaise with relevant stakeholders on outstanding and incorrect Id numbers and where the person is covered on the application form but does not exist on the system

• Liaise with Client services where the deceased died before the policy became inactive to activate the policy prior to assessing

• Identify disputes and complaints of complex claims

• Recommend a solution to Senior Manager where claim arises a day before the 6 month waiting period expires

• Update AIMS notes on system

• Be a 2nd validator on captured and authorized claims

• Give feedback on follow-up claims to Section leader

• Forward a spreadsheet of all finalized claims to Section Leader

• Claims pay-out

• Confirm status of the claim if it is approved or declined

• Where the age of the deceased differs with the one on the system apply the penalty formula

• Recommend decline/payment of claims

• Double check the consistency on banking details attached to the claim and the one on the system

• Forward the claim to Manager for payment

• Check the finance list and sign off

• Reconcile information received, processed and finalized

• Compile monthly individual statistics

• Compiling all branch registers month end (Death)

• Present challenges experienced and solutions taken to resolve them

Requirements

• Matric
• NQF 4 in Insurance (Advantage)
• 2 years life insurance in claims
• Intermediate MS Office Word, Excel, PowerPoint

Qualifications

No formal education or certifications are required for this role.

Salary & Benefits

Salary details are not specified.