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Medical Claims Assessor

JOB PURPOSE The purpose of the role is to assess 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 journey. KEY PERFORMANCE AREAS DUTIES Assessment of all claims in line with policy terms, company standards and claims philosophy, including temporary and permanent disability and critical illness claims. Communicating claims decisions in an accurate, structured and clear manner to clients (verbal and written). Proactive engagement with clients to improve the claim assessment and management process. Implementing case management plans to ensure maximum Matric and a tertiary qualification in Occupational Therapy/Physiotherapy/Biokineticist/Chiro. Advanced understanding of medical conditions, treatment protocols and rehabilitation programs. JOB PURPOSE applicable to assist claimants in their return to work journey. KEY PERFORMANCE AREAS DUTIES Assessment of all claims in line with policy terms, company standards and claims philosophy, including temporary and permanent disability and critical illness claims. Communicating claims decisions in an accurate, structured and clear manner to clients (verbal and written). Proactive engagement with clients to improve the claim. nicky@proappoint.co.za

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