GAP Claims Assessor

• 2 years’ experience in a similar role
• Insurance industry experience (essential)
• Medical Aid claims processing and administration experience (essential)
• Ability to work well under pressure
• Commitment to meet daily targets
• Self-motivated
• Having a can do attitude
• Good written and verbal communication skills
• Good negotiation skills
• Good understanding of how medical aids work and operate
• Intermediary MS Office, especially Excel, Word and Microsoft Outlook skills
• Good time management skills
• Works well in a team and independently
• Copes well with pressure and setbacks
• Pro-active and using your initiative

• Check and validate all GAP claim documents received and to request any outstanding documents
• Follow the claims process and capture the claim information onto the system
• Verify and update any client personal information changes on the system policy record
• 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
• Ensure a client’s claim expectation is adequately addressed and managed by applying the TCF principals and effectively communicating with the client or broker regarding their claim
• Meet your daily minimum claim targets with a high level of accuracy and within service turnaround time Maintain and update your daily workflow tasks and queue
• Ensure high priority and escalated claims as identified by management are processed within 2 hours Interact with medical aids, hospitals and medical practitioners regarding medical history and accounts required relevant to assessing the claim

• 08:00 – 17:00 Monday - Friday

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