Careers

Vacancy: GapRisk Administrators
Claims Assessor

About the Employer

GapRisk Administrators (Pty) Ltd is a specialist Underwriting Manager with its core business being the sourcing, administration and servicing of Gap Cover products. Through our associated partners we have access to Gap Cover providers, a dedicated campaign management & distribution capability and administration services which enables us to deliver customised Gap Cover solutions of the highest quality.

The company is seeking another Claims Assessor to join the team. This role will form part of the Administration team, and report to the Claims Manager. Primarily an Administration function, the role will be responsible for the following:

– Effective coordination of the end-to-end policy claims process, i.e.

• Claims administration
• Claims assessment
• Claims authorisation
• Ownership of the policy claims process and associated SLAs
• Collation and evaluation/assessment of claims documentation
• Communication (written and telephonic) with clients regarding the progress and outcomes of claims assessment process
• Liaison/Correspondence with 3rd parties regarding access to information required to assess claims
• Liaison/Correspondence with authoritative and legal entities such as the Council for Medical Schemes, the Ombudsman, etc.
• Thorough evaluation, assessment and authorisation of claims
• Recording and communication of outcomes of claims
• Management and coordination of claims payment runs
• Assistance with other functions within Administration area if and when required Generic key result areas
• Claim Processing and operational effectiveness
• Functions as a subject matter expert in a specific field of administration / product / process
• Resolves technical and complex problems in support of administrative queries/issues
• Personal effectiveness
• Accountable for client service delivery through own efforts
• Accountable for managing own time, tasks and output quality
• Makes increased contributions by broadening individual skills
• Accepts and lives the company values
• Effective team player with high level of interpersonal skills
• Quality Assurance
• Performs quality checks on own work
• Adheres to service and quality standards

Requirements for the role:

• Knowledge and experience of claims processing
• Minimum 3 years’ experience in Medical Scheme/Health Insurance industry
• Very strong client service focus
• Attention to detail
• Strong analytical skills
• Relationship management skills
• Strong administration skills
• Operational efficiency

Desired Work Experience

• 3 to 5 years

Desired Educational Level

• Grade 12 / Matric

If you meet the above requirements and wish to apply for this position, please Apply Here.