- The Life Claims Assistant role is responsible for reviewing clients’ claims and insurance policies, determining eligibility & validity of claims and processing claim payments within the stipulated Turn Around Times (TATs). The role is responsible for a deeper interrogation of life insurance claims to ensure accuracy and adjudicate claim terms and conditions in compliance with organization’s claims guidelines, processes and procedures and ensure there is effective communication with policy holders, beneficiaries and/or claimants.
- Registration of all new claims promptly and acknowledging receipt of the same.
- Processing and payment of Individual life, Group Life, Retrenchment, Credit Life claims and benefits.
- Assembling and analyzing claims to establish liability.
- Monitor and ensure that the key interfaces adhere to the set claims handling standards and escalate non adherence to the management.
- Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
- Respond to both internal claims inquiries concerning benefits, claims process, service providers, and the filing/completion of proper forms.
- Record all claims transactions and maintain accurate claims registers.
- Continuously review of claim accruals to minimize claim reserves.
- Audit and reporting on potential Unclaimed Assets set to be registered with UFAA
- Capture and maintain accurate data to ensure data integrity.
- Ensure compliance with all regulations.
- Handling customer queries & correspondence on individual life policies to enhance seamless customer experience.
- Prepare claims management reports on a monthly basis or as otherwise advised.
- Facilitating the process of Group & Credit scheme renewals.
- Follow through to ensure all claims with issues at registration level have been addressed or escalated for action.
- Ensure that all claim documents received for Group & Credit Life claims are uploaded and indexed to Document Management System
- Vetting and analyzing Group & Credit claims as per scope of cover whilst ensuring strict adherence to set guidelines and TAT.
- Monthly tracking of insured reimbursement claims with respective underwriters for payment.
- Reconciliation of reimbursement claims and ensuring all the claims are paid within the agreed TAT.
- Perform daily (or weekly) reconciliations and reviews for both financial transactions and LoB Systems.
- Monthly Quality Assurance assessments.
- Notify brokers and clients of pended and declined claims within set timelines.
- Prepare executive presentations and reports to facilitate project evaluation and process improvement.
- Adhere to claims manual procedures and process.
Knowledge, experience and qualifications required:
- Bachelors’ degree in Commerce, Insurance option, Statistics or related courses.
- 0 – 2 years’ experience in claims processing or customer service or financial services.
Technical/ Functional competencies:
- Knowledge of insurance concepts.
- Knowledge of Life insurance claims processes and procedures.
- Knowledge of insurance regulatory requirements.
Leadership category responsibility framework (Core Competencies)
Emerging Leaders in Britam need to:
- Plan, direct and apply efficiencies and resources in order to optimize output and profitability against time, cost and team targets.
- Effectively communicate strategic and operational departmental goals and objectives to peers and others in order to ensure proper implementation.
- Ensure that department priorities are adhered to and effectively communicated.
- Ensure competent and effective people resources through appropriate coaching, development and people supervision as appropriate.
- Embody a high performance, proactive culture.
- Effectively ensure the adherence to key performance areas, deadlines and goals in order to optimize operational effectiveness.
- Effectively communicate resource needs, possible opportunities and achievements to management in order to aid them in their decision-making.
- Effectively set and monitor priorities and objectives for more junior staff.
- Understand and communicate objectives in relation to the larger organisational impact.
- Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
- Appropriately model the company values while setting the pace and energy for delivering.
- Effectively manage and communicate change within the department in order to increase staff and process effectiveness.
- Provide access to accurate and consistent information and services across all channels.
- Ensure a seamless experience for clients.
- Improve service delivery for clients.
- Engage in continuous brand building to become the trusted partners to clients.