JOB OPPORTUNITY

OneLife is a vibrant insurance company providing Medical and Life insurance products to the cooperate and retail market. As the OneLife tribe, we are unified behind our mission to improve and support the quality of the lives of those we work for, our clients. Join our tribe as we recruit. Claims Assessors (2).

Purpose of the Job

Responsible for processing of group, branches and Institutions claim benefits.

Duties and Responsibilities

• Verification of all claims presented to ensure that they fall with the scope of respective insurance policy cover and that policy conditions have been met.
• Acknowledge receipt of new claims and undertake quality assurance checks.
• Process pre-authorisations.
• Attend to HCP and client inquires.
• Vet claims for fraud and over servicing.
• Assist manage client benefit utilisation.
• Process Health Care Providers (HPCs) claims and refunds.
• Maintain cordial relations with HCP’s.
• Reporting any fraudulent activities.
• Assist with other ad hoc assignments as required by the business from time to time.
• Attend to clients on phone with politeness and salesmanship.
• Provide authoritative expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with internal and external stakeholders and clients.
• Participate and contribute to a culture which build rewarding relationships, facilitates feedback and provides exceptional client service.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Take ownership for driving career development.
• Identify opportunities/solutions to enhance business cost effectiveness and increase operational efficiency.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Professional Qualifications and Experience

• Must have at least a first degree from a recognised university.
• Computer literacy.
• One (1) to Two (2) years’ minimum experience in claims handling.
• Knowledge of the insurance industry is of an added advantage.
• Ability to communicate effectively with clients and other stakeholder’s.

• Verification of all claims presented to ensure that they fall with the scope of respective insurance policy cover and that policy conditions have been met.
• Acknowledge receipt of new claims and undertake quality assurance checks.
• Process pre-authorisations.
• Attend to HCP and client inquires.
• Vet claims for fraud and over servicing.
• Assist manage client benefit utilisation.
• Process Health Care Providers (HPCs) claims and refunds.
• Maintain cordial relations with HCP’s.
• Reporting any fraudulent activities.
• Assist with other ad hoc assignments as required by the business from time to time.
• Attend to clients on phone with politeness and salesmanship.
• Provide authoritative expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with internal and external stakeholders and clients.
• Participate and contribute to a culture which build rewarding relationships, facilitates feedback and provides exceptional client service.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Take ownership for driving career development.
• Identify opportunities/solutions to enhance business cost effectiveness and increase operational efficiency.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

• Computer literacy
• Ability to communicate effectively with clients and other stakeholder’s

• At least a first degree from a recognised university
• Computer literacy
• One (1) to Two (2) years’ minimum experience in claims handling
• Knowledge of the insurance industry is of an added advantage
• Ability to communicate effectively with clients and other stakeholder’s