Claims Assessor Klerksdorp

Posted 2 months ago


Our client in Klerksdorp Johannesburg is looking for a Claims Assessor.
The applicant must have the following qualifications:
Qualifications and Experience Required:
  • Matric
  • Degree/Diploma in either
  • Additional insurance related qualifications or training will be advantageous
  • COIDA in Practice or Insurance Qualification an advantage
  • Occupational Therapist or Physiotherapist preferably with EB experience
  • At least 5 years’ Claims Assessor experience
  • COIDA knowledge
The duties includes the following:
  • Review claim cases to determine validity and verification of cover
  • Medical management of Severe Injury claims
  • Follow up on outstanding medical reports with Medical Service Providers
  • Review and updating of ICD10 codes
  • Management of claims in terms of companies Maximum Medical Improvement
  • The confirmation of the calculation of Permanent Disability
  • Extension of Temporary Total Disablement based on medical evidence
  • Authorization of payment of Temporary Total Disablement
  • Adherence to Company Standard Operating Procedures
  • Adjudication of Claims in terms of Injury sustained and ICD 10 Codes
  • Processing of claims documents including capturing of key information on the claims system
  • Medical Report capturing
  • Assessment of Impairment
  • Validation of information on medical reports
  • Thorough review of claims to ensure that there is no missing or incomplete information
  • Keeping meticulous records of claims and follow up on lapsed cases
  • Ability to provide immediate response to enquiries and complaints from claimants
  • Co-ordinate with Medical Service Providers to investigate questionable claims

Knowledge, Skills and Competencies:

  • Ability to work under pressure
  • Attention to detail
  • Verbal and written communication skills
  • Professional personal presentation
  • Customer service orientation
  • Information management
  • Organizing and planning
  • Building Customer Loyalty
  • Contributing to Team Success
  • Managing Work (Includes Time Management)
  • Initiating Action
  • Stress Tolerance
  • Decision Making
  • Extensive knowledge of Medical terminology and Healthcare tariffs

Job Features

Job CategoryClaims Assesor, Insurance, Medical Insurance

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