Business Unit: Discovery Employee Benefits
Function: Claims Administration
Date: 4 Oct 2024
Position: Claims and Underwriting Administrator
About Discovery
Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best.
About Discovery Corporate & Employee Benefits
Discovery Corporate and Employee Benefits is the first and only employee benefits provider to shape employee behaviour, creating healthier and wealthier workforces.
Key Purpose
Assisting the underwriters with general administration related to underwriting. Ensure brokers are well informed by providing accurate information to them in order to adequately support clients. Compile underwriting status reports. Provide or receive half cost medicals from other insurers. Ensure claim assessments and payment of lump sum benefits (Funeral, death, SIB and ICB) payments. Ensure that all disability claims are processed timeously.
Areas of Responsibility
- Compile a report for brokers from SFE and Compass, send medicals requirements requests to brokers/SC in order to be completed by member for underwriting members’ over the acceptable limit.
- Link the received completed medicals to the system and allocate to the underwriters for a decision.
- Send completed medicals to another insurer on request and/or request completed medicals from other insurer to underwrite member.
- Load members on the system to the smart service team for a nurse to complete required medical documents.
- Access completed medicals from the Smart Service System if not already on SFE.
- Verify the membership on Paradigm, that covers are aligned on SFE and Compass. Ensure member is on SFE.
- Ensure all documents submitted are correct and completed in full. Where documents are missing, source the documents from Meditech or other Pathologists.
- Once all documentation is attached on SFE, complete audit for Member and move it to the Underwriters.
- Investigate reasons for anomalies on any underwriting admin process and troubleshoot.
- Receive claims from Indexing department for assessment of the funeral and death claims - member; child or spouse claims as well as extended family members. Assess each claim by verifying claim details against standard claims requirements.
- Once all documentation has been received, set up payment on the system for verification by second Assessor and Authoriser.
- Issue payment letters and/or claims decision letters to Brokers once payment has been approved.
- Process disability claims (CD, ICB and SIB claims), acknowledge receipt and process accordingly.
- Correspond with the brokers and members when we receive queries relating to their claims.
- Ensure that claims are allocated to the assessor for further assessments.
- Lead the process in ensuring that reminders, close case and suspensions are communicated efficiently and timeously.
Personal Attributes
- Self-starter with a high attention to detail and able to multi-task.
- Good at follow through.
- Exceptional ability to communicate written and orally.
- Problem solving and solution focused.
- Analytical – interpretation.
- Building relationships.
- Coping with pressure (deadlines).
- Time-Management and Organizational Skills.
- Must be team orientated, willing to assist other team members in the office.
- Compassionate to those in dire situations or going through difficult transitions.
- Outstanding customer service skills.
Education and Experience
- Matric – essential.
- Advanced Microsoft Excel proficiency.
- Minimum 1 - 2 years working in Employee Benefits.
- Group Risk claims experience.
- Knowledge of Group Risk industry benefit usage and payments.
Employment Equity
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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