Gap Claims Assessor (Zestlife) MMH250611-7

Role Purpose

• Claims administrative responsibilities in respect of GAP Short Term Insurance Products.
• Ensuring that the principles and outcomes of TCF (Treating Customers Fairly) are practiced and achieved in all duties performed and services provided to Zestlife customers.
  
  

Requirements

• 2-3 Years experience within a medical claims assessing role
• Matric Qualification
• Good understanding of how medical aids work and operate
• Willingness to always assist clients with their claims and requirements
• Kindly note that only applicants with the following relevant experience will be considered for interview:
• Actual Medical Aid claims processing and administration experience
• Insurance industry experience
  
  

Duties and Responsibilities

Required

The duties for which you will be responsible in terms of this contract are briefly listed below and will be subject to amendment from time to time as required based on discussions with your manager:

• To check and validate all GAP claim documents received and to request any outstanding documents
• To follow the claims process and capture the claim information onto the system
• To verify and update any client personal information changes on the system policy record
• To assess the validity of the claim in accordance with the terms and conditions of the clients policy document and to make the relevant claim notes on the system
• To ensure a clients claim expectation is adequately addressed and managed by applying the TCF principals and effectively communicating with the client or broker regarding their claim
• To meet your daily minimum claim targets with a high level of accuracy and within service turnaround time
• To maintain and update your daily workflow tasks and queue
• To ensure high-priority and escalated claims, as identified by management, are processed within 2 hours
• Interacting with medical aids, hospitals, and medical practitioners regarding medical history and accounts required to assess the claim.
• Other administration-related functions
  
  

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