Claim Assessor

With a global presence and a strong local footprint in Mauritius our diverse team collaborates across borders to drive excellence, innovation, and results that make a real difference to our clients worldwide.

• Evaluate and enforce claim benefits and limitations based on the understanding of the applicable policy wording or client direction as documented in the process flows/SOPs
• Qualify claims/ bills for payment
• Contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges
• Direct bills to the appropriate internal financial process
• Ensure the client/customer is treated fairly and that the customer receives excellent service in accordance with industry and company guidelines
• Investigate potentially fraudulent claims and escalate them to supervisor
• Be flexible to work outside local office hours when required
• Support department with information on how to proceed with the claim and provide clarifications and support when needed
• Collect accurate information and documents to proceed with a claim, make appropriate decisions and complete tasks based on SOPs
• Analyse a claim made by a policyholder to establish whether it satisfies the policy conditions, request information, follow ups when needed based on SOPs
• Handle any complaints associated with a claim based on provided guidelines and SOPs
• Escalate claims to direct superior when experiencing a situation outside the SOPs
• Conduct outbound calls/emails or other communication in relation to claims
• Perform Adhoc tasks as requested by supervisor