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What youll be doing if you get the job: The purpose of this role is responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and accurate decisions on claims worked on. Assessment of income, disability and critical illness claims following policy terms and claims philosophy as well as facilitate case management programmes where applicable to assist claimants in their return to work. Wholl you report to: Youll be based at our head office in Sandton, Johannesburg. Youll report to the Head of Claims responsible for Claims. Your qualifications: Grade 12 (Essential)Relevant tertiary qualification; a medical degree in Nursing, Occupational Therapy, Physiotherapy is preferred Your Outputs (include but is not limited to):Evaluate claims forms and supporting documentation in preparation of making a payment decisionGathering information and various types of reports from medical practitionersCompare the reports to our existing claims criteria to establish if claim is payableDecide on levels of provisions to be raised based on information receivedWriting claims assessment in line with standards/policiesAuditing/QA of work done by peersDeliver claims decisions within the expected turnaround timeDetermine requirements / documents required to evaluate claimsLiaise with relevant re-insurers to determine validity of claims and get their approvals where requiredExplain and communicate final decisions to brokers and clientsCreate schedules for payments and obtain relevant approvalsCommunicate with relevant stakeholders throughout the claims processAssist other team members with complex mattersAdhoc project involvementPerform validation of policies in line with business and industry standard rules. Your experience:Minimum 3-5 years experience as a Claims assessor, preferably in a Senior positionExperience in both group and life individual life claims (Essential)Sound Business and Operational knowledge of Insurance Industry administrative processesGood knowledge of the business administration platformsFamiliar with Compliance Processes and Procedures in the Insurance Industry
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly9lbi16YS53aGF0am9icy5jb20vY29vcG9iX19jcGxfX18xMTA5XzE4MzI1N19fNDk3P3V0bV9zb3VyY2U9Z3VtdHJlZSZ1dG1fbWVkaXVtPWZlZWQma2V5d29yZD0=&jid=1776882&xid=1109_183257
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KEY ACCOUNTS MANAGERQualifications and Experience:Essential: Matric or an equivalent Senior Certificate.Degree in Sales and Marketing or a related fieldAdvantage: Postgraduate qualification in Commerce orPharmacyACCOUNT MANAGEMENT: Establish and maintain strong working relationships with medical aid organizations, including insurers, managed care organizations, and third-party administrators. Serve as the main point of contact for medical aid organizations, proactively engage in regular communication and build trust. Collaborate with medical aid representatives to negotiate contracts, pricing agreements, and reimbursement terms that align with the pharmacy groups objectives. Facilitate effective communication between the pharmacy group and medical aid organizations, ensure accurate and timely exchange of information. Act as a liaison to resolve any issues or concerns raised by medical aid organizations, coordinate with relevant departments within the pharmacy group to address them promptly. Provide regular updates to both internal and external stakeholders regarding changes in medical aid policies, formulary updates, and other relevant information. Identify growth opportunities within assigned accounts and develop strategies to capitalize on them.FORMULARY MANAGEMENT: Work closely with medical aid organizations to understand their formulary requirements and ensure the pharmacy groups compliance with those guidelines. Collaborate with pharmacy and clinical teams to ensure that the pharmacy groups product offerings align with the medical aid organizations preferred drug lists. Assist in the development and implementation of strategies to maximize formulary access and reimbursement for the pharmacy groups products.STAKEHOLDER LIAISON Build and nurture strong relationships with key decision-makers within medical schemes and healthcare organizations. Act as the primary point of contact for key accounts, addressing their needs, resolving issues, and ensuring customer satisfaction.PERFORMANCE MONITORING AND REPORTING: Monitor and evaluate the pharmacy groups performance with medical aid organizations, including key performance indicators (KPIs) such as claims processing, medication adherence, and patient satisfaction. Generate reports and analyze data to identify trends, opportunities, and areas for improvement. Present findings and recommendations to internal stakeholders and medical aid organizations to optimize operational processes and enhance patient outcomes. Stay updated on industry trends, market conditions, and competitor activities to proactively identify new business opportunitiesGENERAL: Adhere to Dis-Chem Policies and Standard Operating Procedures. Adhere to Health and Safety rules and regulations.
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly9lbi16YS53aGF0am9icy5jb20vY29vcG9iX19jcGxfX18xMTA4XzE3NzI5NF9fNDk3P3V0bV9zb3VyY2U9Z3VtdHJlZSZ1dG1fbWVkaXVtPWZlZWQma2V5d29yZD0=&jid=1776715&xid=1108_177294
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You must have at least 7 years of Short Term Insurance Claims & Underwriting Experience in Commercial Lines
Matriculation certificateRE5NQF 4CPD Points up to dateInsurance qualification (preferred) – 120 credits higher certificate or equivalentTeam PlayerSelf-driven and able to start working independently in the near future with the company policy framework
Duties:
Understand a client’s needs from the scenario givenUnderstand when more information is required in order to process the claimAddress all claims within the agreed turnaround times as per the procedure manual/service agreementsWork with the Broker/Account Executive to understand progress on the claim and any issues/delaysEnsure that audit requirements as per insurer binders and/or intermediary arrangements are met before approving the claim paymentMeet with the Broker/Account Executive on a regular basis to discuss claims on the portfolioRegister the claim on the system and ensure all documents are saved correctlyEnsure documents are always in order and system/estimates input is updated and correctAdvise underwriters when there are amendments to be made on a policyEnsure compliance to all processes, policies and procedures and identify areas for improvementTake responsibility for managing own time and delivery
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8xMzkzMDgwMjU2P3NvdXJjZT1ndW10cmVl&jid=1169476&xid=1393080256
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Our client is an international insurance company, specialist in international wellbeing offering a variety of international insurance products. They are seeking to employ a Membership Advisor to provide and effective customer service and claims assessment function to their key distributors and members based worldwide.
Requirements:
At least 2 – 5 years’ experience in a similar role.Grade 12 or Equivalent NQF Level 4 QualificationFAIS Compliant is an advantageCustomer service certificateSound knowledger of industry regulatory requirementsHigh standard of written English is essentialExcellent communicator in English, both written and verbalExcellent administration skills
Duties:
Initial underwriting of new applications, referring to medical underwriters as appropriate.Entering new group schemes and members onto database.Processing of renewals.Production of Policy Schedules and membership packs.Provide first class customer service to members, responding to enquiries by email, telephone, and letter.Liaison with Distributors and Brokers globally.Ensure all necessary administrative tasks are completed accurately and within agreed time limits.To consider and abide by the Data Protection Act, particularly in respect of the handling of sensitive medical data.To consider and abide by guidelines, regulations and standards always set by the FCA.Always adhere to departmental Service Level Agreements.Production of Life & Personal Accident documentation under the direction of the Senior Operations Adviser.Assessment of existing processes and evaluation and implementation of possible improvement solutions.Testing of new processes and procedures in concert with the Operation Team Manager.
Key skills:
Excellent administration skills.Sound knowledge of industry regulatory requirements.Excellent communicator at all levels, able to listen and respond effectively to others, with the ability to translate the needs of customers into working procedures.Highly organised and able to implement an effective time management system to plan and prioritise own workload.Great team player.Good problem-solving skills and ability to work on own initiative when required.People focused and customer orientated.Culturally aware.High standard of written English.
Salary: Market related
Closing date: 31 May 2023
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy (at) letslink .co .zaPlease view our website:...
https://www.ditto.jobs/job/gumtree/3808582964?source=gumtree
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Claims Administrator - Johannesburg (Part time)
LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers to recruit 4 part time Claims Administrators.
Requirements:
MatricRE5 qualification is essentialPrevious Medical Aid Claims experience (Gap Cover Claims an advantage)Start working immediately
Skills and experience:
At least 2 years’ Medial Aid or Gap Cover claims experienceTechnical knowledge on various health insurance products.Knowledge of ICD 10 and CPT Codes, medical procedures, and medical aid schemes.Understanding of PMB legislation in conjunction with Gap Cover.Sound computer skills - Microsoft Office a must.Excellent customer service skills.Takes ownership and responsibility.Ability to work in a team with minimal supervision.Pays attention to detail.Excellent analytical skills.Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
Location: Bryanston Johannesburg
Salary: between R12000.00 and R14000.00 per month
Closing date: 18 March 2022
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to ( vacancy @ letslink. co . za)Please view our website: www. letslink . co . za
https://www.ditto.jobs/job/gumtree/2576237741?source=gumtree
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LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Clinical Risk Manager.
Requirements:
MatricRegistered Nursing diplomaValid membership of SANCClaims and Forensic Risk management certificationRegistration with the Association of Certified Fraud Examiners (ACFE SA)
Skills and experience:
At least four (4) years’ experience in provider utilization and fraud management.A thorough understanding of SA’s medical terrain - legislation, growth opportunities, etc.Strong interpersonal skills and the ability to engage various parties appropriately for optimal outcomes.Strong analytical and problem-solving skills and pays attention to detail.Superior judgment, negotiation, and decision-making skills.Strong ethics and a high level of personal and professional integrity.Ability to liaise with external parties – clinicians and members.Ability to manage a multidisciplinary team.Excellent verbal and writing communication skills.Computer literate – proficient in MS Office suite.Sound understanding of evidence-based medicine principles and embracing health economic principles and tools.
Location: Gauteng
Closing date: 30 September 2022
Interested candidates who meet the above criteria are requested to e-mail a detailed CV to ( vacancy @ letslink. co . za ) or to contact Gary on +27(0)110261907
Correspondence will only be conducted with short listed candidates. Should you not hear from us within 7 days, please consider your application unsuccessful.
Please view our website: www . letslink . co . za
By applying for this position and providing us with your CV and other personal information, you are consenting to the information being used for the specific purpose for which it was provided, which is recruitment purposes and possible appointment purposes (Should you be successful). Please note that your information will be processed for recruitment purposes only or for such purposes relating to assessing the establishment of the employment relationship with yourself, and this will be done in accordance with the applicable data protection and privacy legislation. We confirm that such information will not be used for any other purpose without your prior consent.
If your application is not successful, we retain your CV and other information provided for a period of 24 months after which it will be destroyed in a secure manner. If you object to your information being used in accordance with the aforementioned clauses, please indicate your objection and we will...
https://www.ditto.jobs/job/gumtree/1723580125?source=gumtree
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Claims Administrator Temp- Johannesburg
LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Claims Administrator on a temporary bases.
Requirements:
MatricFAIS Compliant (RE5 & Qualification are a pre-requisite)Customer service certificate
Skills and experience:
At least 2 years’ gap cover or medical claims experience.Technical knowledge on various health insurance products.Knowledge of ICD Codes , medical procedures, and medical aid schemes.Understanding of PMB legislation in conjunction with Gap Cover.Sound computer skills - Microsoft Office a must.Excellent customer service skills.Takes ownership and responsibility.Ability to work in a team with minimal supervision.Pays attention to detail.Excellent analytical skills.Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
Location: Gauteng
Closing date: 29 April 2022
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy @ letslink.co.zaPlease view our website: www. letslink .co.za
https://www.ditto.jobs/job/gumtree/3348600255?source=gumtree
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LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Case Manager.
Requirements:
MatricRegistered Nursing diplomaValid membership of SANCClaims and Forensic Risk management certificationRegistration with the Association of Certified Fraud Examiners (ACFE SA)
Skills and experience:
At least 2-3 years’ experience in a similar role.MIP Application System experience and advantage.Sound understanding of the South African Health Industry, benefits, and options, etc.ICD codes, modifiers, and RPL tariff knowledge and understanding.Ability to liaise with external parties – clinicians and members.Ability to work within an established team.Excellent oral and written communication skills.Customer-centric attitude.Excellent analytical skills and pays attention to detail.Computer literate - MS Office suite, i.e., Word, Excel.A good understanding of claims risk profiling.Experience in claims auditing.
Location: Johannesburg Gauteng
Closing date: 29 April 2022
Interested candidates who meet the above criteria are requested to e-mail a detailed CV to ( vacancy @ letslink. co . za ) or to contact Gary on +27(0)110261907
Correspondence will only be conducted with short listed candidates. Should you not hear from us within 7 days, please consider your application unsuccessful.
Please view our website: www . letslink . co . za
By applying for this position and providing us with your CV and other personal information, you are consenting to the information being used for the specific purpose for which it was provided, which is recruitment purposes and possible appointment purposes (Should you be successful). Please note that your information will be processed for recruitment purposes only or for such purposes relating to assessing the establishment of the employment relationship with yourself, and this will be done in accordance with the applicable data protection and privacy legislation. We confirm that such information will not be used for any other purpose without your prior consent. If your application is not successful, we retain your CV and other information provided for a period of 24 months after which it will be destroyed in a secure manner. If you object to your information being used in accordance with the aforementioned clauses, please indicate your objection and we will immediately destroy your personal information in a secure manner.
https://www.ditto.jobs/job/gumtree/816031602?source=gumtree
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Claims Administrator - Johannesburg
LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Claims Administrator.
Requirements:
MatricFAIS Compliant (RE5 & Qualification are a pre-requisite)Customer service certificate
Skills and experience:
At least 2 years’ gap cover or medical claims experience.Technical knowledge on various health insurance products.Knowledge of ICD Codes , medical procedures, and medical aid schemes.Understanding of PMB legislation in conjunction with Gap Cover.Sound computer skills - Microsoft Office a must.Excellent customer service skills.Takes ownership and responsibility.Ability to work in a team with minimal supervision.Pays attention to detail.Excellent analytical skills.Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
Location: Gauteng
Closing date: 30 September 2022
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy@letslink.co.zaPlease view our website: www.letslink.co.za
https://www.ditto.jobs/job/gumtree/866882812?source=gumtree
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LetsLink recruitment is currently seeking a highly motivated and experienced Claims Administrator to work in Johannesburg.
. Qualifications:
Matric (Grade 12) or equivalent.FAIS (Financial Advisory and Intermediary Services) compliant.RE 5 (Representative Exam) certification.Customer Service Certificate (advantageous).Clinical qualification as an Enrolled or Registered Nurse.
Skills and Experience:
2-3 years of working experience in a hospital setting.2-3 years of experience as a Claims Assessor specializing in death claims and hospital cash back claims.Technical knowledge of various health insurance products.Proficient knowledge of ICD codes, medical procedures, and medical terminology.Sound computer skills, including proficiency in relevant software applications.Excellent writing skills, with attention to detail and accuracy.Strong organizational and time management skills.Exceptional customer service skills, with the ability to communicate effectively and empathetically.
If you meet the qualifications and are interested in this exciting opportunity, please submit your application today to vacancy at letslink dot co dot za or contact Gary on 011 0261907
Please view our website: letslink dot co dot za and contact Gary.
By applying for this position and providing us with your CV and other personal information, you are consenting to the information being used for the specific purpose for which it was provided, which is recruitment purposes and possible appointment purposes (Should you be successful). Please note that your information will be processed for recruitment purposes only or for such purposes relating to assessing the establishment of the employment relationship with yourself, and this will be done in accordance with the applicable data protection and privacy legislation. We confirm that such information will not be used for any other purpose without your prior consent.
https://www.ditto.jobs/job/gumtree/3181360862?source=gumtree
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Rand Mutual Assurance invites applicants to apply for the 2023 Learnerships Programme based in Parktown Johannesburg. The duration of this Learnerships programme is 12 months and will commence in January 2023.
We are currently looking to fill 10 Learnerships below:
Claims Management Learnership (COID)
Qualifications and Experience required
National Senior CertificateHigher Certificate or Diploma in Business ManagementMust be unemployed.Must be a South African citizen
Claims Management Learnership (LIFE)
Qualifications and Experience required
National Senior CertificateHigher Certificate or Diploma in Business ManagementMust be unemployed.Must be a South African citizen
Risk and Compliance Learnership
Qualifications and Experience required
National Senior CertificateLegal/ Risk management/ Compliance management/ Insurance/ general business management.Must be unemployed.Must be a South African citizen
Contact Centre Learnership
Qualifications and Experience required
National Senior CertificateBSc Maths/Computer Science/Stats - to work under MIS/Workforce AnalystMust be unemployed.Must be a South African citizen
Collections Learnership
Qualifications and Experience required
National Senior CertificateAccounting DiplomaMust be unemployed.Must be a South African citizen
Finance Learnership
Qualifications and Experience required
National Senior CertificateAccounting DegreeMust be unemployed.Must be a South African citizen
HR Administrator Learnership
Qualifications and Experience required
National Senior CertificateHR DiplomaMust be unemployed.Must be a South African citizen
Business Integration Learnership
Qualifications and Experience required
National Senior Certificate.Com/Business Admin degree focusing on Strategy will be an advantage.Must be unemployed.Must be a South African citizen
Life Operations Learnership (PWD)
Qualifications and Experience required
National Senior CertificateProcess Engineering Diploma.Lean Six Sigma certificate.https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8xNjc5OTY5MDk4P3NvdXJjZT1ndW10cmVl&jid=1345343&xid=1679969098
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Claims Administrator - Johannesburg
LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Claims Administrator.
Requirements:
MatricFAIS Compliant (RE5 & Qualification are a pre-requisite)Customer service certificate
Skills and experience:
At least 2 years’ gap cover or medical claims experience.Technical knowledge on various health insurance products.Knowledge of ICD Codes , medical procedures, and medical aid schemes.Understanding of PMB legislation in conjunction with Gap Cover.Sound computer skills - Microsoft Office a must.Excellent customer service skills.Takes ownership and responsibility.Ability to work in a team with minimal supervision.Pays attention to detail.Excellent analytical skills.Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
Location: Gauteng
Closing date: 11 February 2022
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy@letslink.co.zaPlease view our website: www.letslink.co.za
https://www.ditto.jobs/job/gumtree/1165560927?source=gumtree
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Our client is an international insurance company, specialist in international wellbeing offering a variety of international insurance products. They are seeking to employ a Claim Advisor to assist them in the processing of medical claims.
If you have extensive healthcare claims experience in the healthcare insurance industry and are in the market for a new opportunity, then this job is for you. They are looking for a candidate that can provide high quality and efficient claims assessment function to their key distributors and members based worldwide.
Requirements:
MatricFAIS Compliant is preferred.Minimum 3 to 5 years’ experience.Customer service certificate.High standard of written and verbal English communication and an excellent communicator on all levels.Good problem-solving skills and the ability to work on own initiative when required.Highly organised and able to implement an effective time management system to plan and prioritise own workload.Excellent administration skills.International Health Insurance experience is an advantage.
Duties:
Assessment and processing of medical claims.Provide first class customer service to members, responding to enquiries by email, telephone, and letter.Liaison with Distributors and Brokers globally.Ensure all necessary administrative tasks are completed accurately and within agreed time limits.To consider and abide by the Data Protection Act, particularly in respect of the handling of sensitive medical data.To consider and abide by guidelines, regulations and standards as set by the FCA.Always adhere to departmental Service Level Agreements.Production of Life & Personal Accident documentation under the direction of the Senior Operations Adviser.Assessment of existing processes and evaluation and implementation of possible improvement solutions.Testing of new processes and procedures in concert with the Operation Team Manager.
Closing date: 31 May 2023
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy @ letslink.co.za
Please view our website: www. letslink .co.za
Our consultants will contact short listed candidates within 7 days of receipt of your application, should you not be contacted within 14 days of applying for the vacancy, please consider your application unsuccessful
https://www.ditto.jobs/job/gumtree/1860035513?source=gumtree
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LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Claims Advisor.
Requirements:
MatricFAIS Compliant (RE5 & Qualification are a pre-requisite)Customer service certificate
Skills and experience:
At least 2 years’ gap cover or medical claims experience.Technical knowledge on various health insurance products.Knowledge of ICD Codes, medical procedures, and medical aid schemes.Understanding of PMB legislation in conjunction with Gap Cover.Sound computer skills - Microsoft Office a must.Excellent customer service skills.Takes ownership and responsibility.Ability to work in a team with minimal supervision.Pays attention to detail.Excellent analytical skills.Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
Location: Gauteng
Closing date: 19/05/2023
Candidates who meet the relevant requirements must please apply by contacting Gary on 011 0261907 or email a detailed CV to vacancy @ letslink.co.za
Please view our website: www. letslink .co.za
Our consultants will contact short listed candidates within 7 days of receipt of your application, should you not be contacted within 14 days of applying for the vacancy, please consider your application unsuccessful.
https://www.ditto.jobs/job/gumtree/620208128?source=gumtree
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LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Wellness Specialist.
Requirements:
MatricRegistered Pharmacy AssistantValid membership of the South African Pharmacy CouncilClaims and Forensic Risk management certification (will be an advantage)
Skills and experience:
At least 5 years’ experience as a registered Pharmacy Assistant.Sound understanding of the South African Health Industry, benefits, options, etcMIP Application System experience and advantage.Ability to liaise with external parties – clinicians and membersICD codes, modifiers, and RPL tariff knowledge and understanding.Ability to liaise with external parties – clinicians and members.Ability to work within an established team.Excellent oral and written communication skills.Customer-centric attitude.Excellent analytical skills and pays attention to detail.Computer literate - MS Office suite, i.e., Word, Excel.A good understanding of claims risk profiling.Experience in claims auditing.Good understanding of evidence-based medicine principles and embracing health economic principles and tools.A good understanding of the principles of healthcare funding design will be an advantage.
Location: Johannesburg
Closing date: 29 April 2022
Interested candidates who meet the above criteria are requested to e-mail a detailed CV to ( vacancy @ letslink. co . za ) or to contact Gary on +27(0)110261907
Correspondence will only be conducted with short listed candidates. Should you not hear from us within 7 days, please consider your application unsuccessful.
Please view our website: www . letslink . co . za
By applying for this position and providing us with your CV and other personal information, you are consenting to the information being used for the specific purpose for which it was provided, which is recruitment purposes and possible appointment purposes (Should you be successful). Please note that your information will be processed for recruitment purposes only or for such purposes relating to assessing the establishment of the employment relationship with yourself, and this will be done in accordance with the applicable data protection and privacy legislation. We confirm that such information will not be used for any other purpose without your prior consent.
If your application is not successful, we retain your CV and other information provided for a period of 24 months after which it will be destroyed in a secure manner. If you objec...
https://www.ditto.jobs/job/gumtree/75646236?source=gumtree
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Are you an experienced Claim Handling professional with experience in a large insurer?
If you are keen to develop your skills and progress your career within one of the worlds largest insurers then we would love to hear from you !
This role plays a key part of our South African Claims function and requires delivery of efficient and professional claims service across the Property portfolio in South Africa.
The primary function is to achieve the best possible outcome of all claims presented by working closely with TPA’s, brokers and clients and offering support when required and to ensure that only claims that fall within the scope of the cover are paid accurately and efficiently.
Another key element is ensuring that sound and thorough practices are adhered to when performing coverage & loss verification analyses and liaising with the claims managers, local underwriters, finance and other business areas is an integral part of this role.
KEY RESPONSIBILITIES:- Processing new insurance claims notifications and guiding insured/broker on how to proceed with the claim
- Collecting accurate information and documentation to continue with the assessment of a claim
- Assess claims in accordance with Chubb’s service level and quality requirements and the General Insurance Code of Practice. This includes determining coverage, reserving within timeframes, making payments, responding to customer queries, providing updates, and requesting additional information as needed to manage a claim.
- Ensure systems, procedures and controls are followed and make sure claims are investigated adequately, reserves are posted promptly and accurately and are monitored and updated timeously.
- Ensure that valid claims are paid and provide support in respect of all high profile claims that impact the business and ensure they are brought to a successful conclusion. This may involve liaison with policyholders, other professionals, insurers, loss adjusters, brokers, attorneys, LOB heads and third parties by letter, telephone, or meetings.
- Monitor performance and processes of service providers, raising breaches to Claims Management.
- Handling any complaints associated with a claim and alert underwriters on accounts that attract high frequency losses for preparation of renewal terms
- Monitoring and handling of any recoveries and applying the Key fraud Indicators to the claims. Ensuring the customer is treated fairly and that the customer receives excellent service.
REQUIRED SKILLS AND EXPERIENCE:- Relevant Insurance Industry Qualifications preferred
- Claims experience required (Property experience advantageous)
- Strong negotiation, written and verbal communication skills
- Demonstrable Claims product knowledge with a strong Client Focus
- Results driven with ability to handle high claims volumes daily
- Able to work under pre...
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8yMDQzOTIzODczP3NvdXJjZT1ndW10cmVl&jid=376442&xid=2043923873
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Ready to Lead with Heart? Join Our client as Our Personal Lines Claims Team Leader!
Are you a compassionate and skilled leader in the insurance industry, ready to make a meaningful impact on peoples lives? Are you passionate about guiding a team to provide exceptional support during lifes unexpected twists and turns? If so, our client is searching for a dynamic Personal Lines Claims Team Leader to steer their team toward success!
About our client:
Theyre not just an insurance company; theyre guardians of peace of mind, champions of resilience, and partners in protection. Their commitment to their clients goes beyond policies; its about being there when they need them most.
The Role:
As a Personal Lines Claims Team Leader, youll play a pivotal role in their mission to provide exceptional support and peace of mind. Your responsibilities will include:
Leading and inspiring a team of claims professionals to deliver top-notch service. ? Managing and overseeing the claims process, ensuring efficiency and accuracy. ? Empathizing with policyholders during challenging times and finding solutions. ? Analyzing claims data to identify trends and improve processes. ???? Collaborating with cross-functional teams to enhance customer experience. ???? Fostering a culture of continuous improvement and growth within your team. ? Contributing to the strategic direction of their claims department.
What they Offer:
A Supportive Family: Be part of a tight-knit community that values collaboration, empathy, and growth.
Professional Development: Theyre invested in your success and offer opportunities for training and career advancement.
Impactful Work: Help policyholders regain their peace of mind and resilience during challenging times.
Requirements:
Experience in personal lines claims, with a deep understanding of insurance principles ,Exceptional leadership and interpersonal skills, with the ability to motivate and inspire. ? Strong analytical and problem-solving abilities. A passion for continuous improvement and innovation. Empathy and a genuine commitment to providing the best customer experience. Proficiency in claims management software and tools.
Why our client?
They believe in the power of compassion, innovation, and community. Theyre not just looking for a Personal Lines Claims Team Leader; theyre seeking a compassionate leader who embodies their values and is dedicated to making a difference.
Join our client in being a beacon of hope during lifes storms. Together, youll make a difference, one claim at a time!
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8xMzQ2MDI4NzMzP3NvdXJjZT1ndW10cmVl&jid=1705691&xid=1346028733
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A top company in the insurance industry is seeking a Client Services Administrator to start in their Branch administration department in Rustenburg.
Purpose
To provide professional first line support to clients and sales support
Responsibilities
Render client services: updating client personal details, inform clients and update changes to their policy, handle all complaints and enquiries.Administrate Claims: Verify claim documents as per standard procedure, submit all claims received to head office, keep claims register up to date.Advise clients of cancelationsOffice Administration: Manage mail and fax, prepare statistical reports.
Requirements
Must have Matric.A recognized qualification as per the FSCA will be advantageous.Must have an RE5. Must have registration as an Employee RepresentativeMust have CPD pointsMust have Class of Business CertificateMust have at least 2 years Experience in the insurance industryMust have 1 year Client services experience.Must have 1 year experience in: Category A, B, C and retail benefits will be advantageous.
https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8xODI2NDEyNDI5P3NvdXJjZT1ndW10cmVl&jid=1746577&xid=1826412429
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Duties and Responsibilities:• Capturing of all new claim where applicable.• One point of contact for the client/broker and adherence to first call resolution.• Deliver exceptional client service that exceeds customers’ expectations through proactive, innovative and appropriate claims handling.• Ensures that customer claim is handled efficiently.• Verifies FNOL data or documentation provided to ensure correct settlements of claim • Attend to validation and first call actions on all claims within 1 working hour after registration.• Achieve minimum targets were applicable.• Maintain appropriate diaries and messages on the operating system.• Client input and communication is an integral part at the start of the entire claims value chain, ensuring that complete and accurate data/documentation is obtained and captured. This determines the direction of the claim to the entire claims value chain.• Effectively maintains oversight of all relevant claims tasks and manages the claims handling process to achieve timely settlement and to minimise inaccuracies• Identify, investigate and resolve any issues relating to claims being handled in line with claims policies and procedures such as SLAs and TAT.• Accurately check/determine whether appropriate cover is in place, interpret policy wordings and conditions to determine the validity of claims and advises the broker/policyholder accordingly.• Identify potential non-disclosure and misrepresentation cases and follow Insurers procedures to deal with these situations.• Identify any red flags on claims which are potentially fraudulent and follow Insurer procedures for dealing with these.• Identify when a specialist is needed to investigate a claim and follow Insurers policies and procedures for appointing these.• Identify possible recovery and third-party claims and link the claim to the legal department upon registration.• Negotiates effectively within agreed mandate limits using an appropriate negotiation style.• Be familiar with the Insurers estimate philosophy and apply accordingly.• Adhere to Brolink s guidelines for referral of claims to management (e.g., large losses)• Selects and appoints external experts/vendors following Insurers procedures and authority levels.• Utilises preferred service suppliers when dispatching service to clients in line with BBEEE targets e.g., Spend direction tools.• Assist with emergencies and afterhours process for outsourced business.
• Minimizes cash settlements vs utilization of preferred suppliers for settlement by managing the percentage of cash versus quantum. • Demonstrates an effective communication style, that motivates, across internal and external teams and individuals that may become involved with claim tasks.https://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS80OTEwMzc0MTU/c291cmNlPWd1bXRyZWU=&jid=1705689&xid=491037415
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COMPLIANCE FUNCTIONS:
Assist in monitoring compliance with applicable legislation and internal requirements.Fulfils Compliance functions required in terms of the FAIS legislations such as monitoring and reporting to the financial services provider and the FSCA when required.Identifies and assess compliance risk areas periodically and appropriately address findings through relevant and appropriate action plans processes. Escalate any concerns to business immediately.Assist with the proper establishment and maintenance of procedures on the identification, reporting and resolution of breaches and other compliance and regulatory issues.Maintain and update all legislative Registers bi-monthly.Track and monitor all representatives FSCA Deadlines and ensure compliance, Complete FSCA exemptions when required.Assist reps with completing Exemption applications. Oversee SBIB Supervision and conduct monthly meetings with the supervisors.Manage the PI Insurance/ Claims for projects and FSP.
Key Individual FUNCTIONS: Long Term (Sub Cat - 1.1; 1.3; 1.22)
Stay up to date with legislation and FSCA board notices.Maintain the FSP’s legislative registers.Ensure the representatives remain Fit ad proper.Add and remove representatives on the rep register, update the rep register with reps status changes or sub category change.Create rep letters for all representatives.Create supervision agreements for representatives working under supervision and conduct monthly supervision.Ensuring the FSP maintains their Fit and Proper status, ensure all actions such as incentives align with the FAIS act.Debar representatives who are in contravention of the FAIS act.Manage the FSP relations with the Compliance practice, implement changes and policies brought to the FSP’s attention by the compliance practice.Manage and update the FSP’s policies such as the Complaints policy, FICA policy and Business continuity policy.Ensure all staff are trained on the GCOC, FICA, POPIA annually.HIGS And Financial Declaration to be completed by all staff annually.
PROJECT ONBOARDING:
Ensure that the content of the packs are completed as per the client requirements and that minimal back and forth is managed upfront.Liaise with the various FAIS teams of the client as well as the necessary EAW personnel to manage the sign off process of the Packs.Streamline processes to optimize efficiencies.
COMPANY AND CLIENT ENGAGEMENThttps://protool.gumtree.co.za/external-link-browser.html?url=aHR0cHM6Ly93d3cuZGl0dG8uam9icy9qb2IvZ3VtdHJlZS8zNDE1MDkxMzg1P3NvdXJjZT1ndW10cmVl&jid=1555436&xid=3415091385
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