Medical Scheme jobs in Discovery, Gauteng

Insurance Claims Specialist

The role is primarily office-based and requires strong attention to detail, excellent communication skills, and the ability to work under pressure.

Key Responsibilities

• Gather complete and accurate details of insurance claims from clients.
• Assess and process motor, personal, commercial insurance claims.
• Work with insurers and loss adjusters to investigate and validate claims.
• Liaise with clients, underwriters, service providers, and other stakeholders throughout the claims process.
• Ensure clients receive fair settlements in accordance with policy terms and conditions.
• Maintain regular communication with clients to provide updates and ensure excellent customer service.
• Prepare, review, and maintain accurate claims documentation and records.
• Manage Motor Aggregate Funds by monitoring, allocating, and reconciling claims the to pay multiple motor-related claims under an agreed facility or annual limit. This includes ensuring claims are paid within the available aggregate amount, tracking fund utilisation, identifying potential shortfalls, and providing accurate reporting to insurers and management.
• Liaise with Medical Aid Schemes regarding member benefits, authorisations, claims submissions, and payment queries to ensure timely processing and resolution of healthcare-related claims.
• Handle claims involving Long-Term Insurers, including life, disability, income protection, and critical illness policies, ensuring compliance with policy requirements, gathering supporting documentation, and facilitating efficient claim settlements.

Skills and Competencies

• Strong analytical and problem-solving skills.
• Ability to understand and interpret technical insurance information.
• Sound decision-making and judgement.
• Excellent numerical and financial reconciliation skills.
• Strong interpersonal and communication abilities.
• Effective negotiation and conflict-resolution skills.
• High level of accuracy and attention to detail.
• Ability to prioritise workloads and meet tight deadlines.
• Ability to work independently and use initiative.
• Proficiency in Microsoft Excel.

Work Environment

• Primarily office-based with regular interaction with clients, insurers, brokers, medical aid administrators, long-term insurers, assessors, and service providers.
• Fast-paced environment requiring effective time management and the ability to manage multiple claims simultaneously while maintaining high standards of customer service and regulatory compliance.

Pay: R20 000,00 - R30 000,00 per month

Experience:

• Insurance: 5 years (Required)

Work Location: In person