Claims Assessor (Medical And Travel Department)

As a Claim Assessor, you will be responsible for evaluating and processing Medical and Travel insurance claims to determine their validity. This role involves investigating claims, gathering relevant information, and assessing the extent of coverage based on policy terms.

Job Description:

As a Claim Assessor, you will be responsible for evaluating and processing Medical and Travel insurance claims to determine their validity. This role involves investigating claims, gathering relevant information, and assessing the extent of coverage based on policy terms. The ideal candidate will have a strong analytical mindset, attention to detail, and excellent communication skills.

Key Responsibilities:

1. Claim Investigation:

Conduct thorough investigations on insurance claims, including reviewing documentation, statements, and evidence to determine the legitimacy of claims.

2. Policy Analysis:

Examine insurance policies to understand coverage limits, terms, and conditions. Interpret policy language and apply it to the specific circumstances of each claim.

3. Communication:

Maintain effective communication with policyholders, claimants, and other stakeholders to gather necessary information and provide updates on claim status.

4. Documentation:

Create detailed reports documenting the assessment process, findings, and decisions. Ensure accuracy and completeness of records.

5. Collaboration:

Collaborate with other departments, such as underwriting and legal, to gather additional information and insights relevant to claim assessments.

6. Negotiation:

Engage in negotiation processes when required, aiming to reach fair and amicable settlements with claimants.

7. Compliance:

Stay up-to-date with industry regulations and company policies. Ensure all claim assessments adhere to legal and ethical standards.

8. Customer Service:

Provide excellent customer service by addressing inquiries, concerns, and providing clear explanations of claim decisions to policyholders.

9. Continuous Improvement:

 Identify opportunities for process improvement and contribute to the development of best practices within the claims department.

Qualifications:

1. Higher School Certificate
2. Proven experience as Claims Assessor or in a similar role (min. 2 years).
3. Effective communication and interpersonal skills
4. Basic IT and computer skills
5. Familiarity with insurance policies, regulations, and industry practices.

Interested candidates are invited to submit their resume, cover letter, and any relevant certifications.