Our client, a prominent provider of innovative and flexible solutions centered around health, wellness, and financial security, is seeking a gap cover assessor to join their team.

 

This position involves validating claim documentation, managing communication with clients, brokers, and medical professionals, and adhering to service turnaround times. As a Claims Assessor, you will contribute to the success of the department by meeting daily claim targets, resolving escalated claims, and maintaining up-to-date workflow queues. If you are self-motivated, thrive under pressure, and have a “can-do” attitude, this is an excellent opportunity to be part of a dynamic and supportive team.

 

Matric 

2 years experience in similar role 

Good negotiation skills and effective in dealing with customers and meeting their expectations 

Good understanding of how medical aids work and operate 

Ability to apply administration principles and work with detail and a high level of accuracy

Proficiency in Microsoft Office 

 

Validate and review all GAP claim documents received, ensuring any outstanding documents are promptly requested.

Accurately capture claim information into the system, adhering to established processes.

Verify and update client personal information on the policy record as required.

Assess the validity of claims in line with the terms and conditions outlined in the client’s policy document and record relevant notes on the system.

Address and manage client claim expectations effectively by applying Treating Customers Fairly (TCF) principles and maintaining clear communication with clients or brokers.

Achieve daily claim targets with precision and within the designated turnaround time.

Maintain and update daily workflow tasks and queues for efficient management and reporting.

Process high-priority and escalated claims identified by management within a two-hour timeframe.

Collaborate with medical aids, hospitals, and medical practitioners to obtain necessary medical history and account details for claim assessments.

Perform general administrative duties as required.

Please do not apply using Scanned CVs, no supporting documentation is required at this point, this will be requested later.

 

IMPORTANT: We specialize in specific niche fields. Regret that we are unable to provide assistance for any fields outside of this scope. Fields can be viewed on our website.

 

Equal opportunity: All backgrounds are welcomed, with no bias. All are considered based on requirements.

Job specifics: Requirements mirror advertisement, duties may adjust for client needs.

Fair process: Fair assessment, only shortlisted candidates contacted due to volume.

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Candidate verification: Candidates selected by the client are verified. False info may disqualify or end employment via the client.

Offer clarity: Advert is not a binding offer. Written offers based on pre-employment conditions.

No direct link: Advert is not tied to Kontak Recruitment. We assist in the employment process ONLY.

Applicant Responsibility: Upon applying, confirmation of receipt for a specific advert is given. If no confirmation is received, you must verify with Kontak Recruitment.