Life Claims Consultant

Purpose:

The Life Claims Consultant is responsible for processing and managing life insurance claims efficiently, accurately, and in compliance with regulatory requirements. This role involves engaging with clients, beneficiaries, and service providers to ensure smooth and empathetic claims resolution while upholding BetterSure’s commitment to excellent client service. The Life Claims Consultant plays a critical role in maintaining client trust and satisfaction through professional and compassionate interactions.

Key Responsibilities:

1. Claims Processing:
   Manage the end-to-end claims process for life insurance, including registration, validation, and settlement of claims.
   Ensure all claims are processed within agreed service level agreements (SLAs) and comply with company policies and regulatory requirements.
   Accurately capture claims information and maintain up-to-date records in the claims management system.
2. Client Service:
   Communicate with clients and beneficiaries to gather necessary information, explain claims processes, and provide updates.
   Handle client queries and concerns with empathy and professionalism, ensuring a positive client experience.
   Provide clear and timely updates on the status of claims to all relevant stakeholders.
3. Investigation and Assessment:
   Verify the validity of life insurance claims by reviewing documentation, including medical reports, death certificates, and policy terms.
   Identify potential fraud or discrepancies and report any suspicious activity to the Claims Manager.
   Liaise with medical experts, legal advisors, and other service providers as needed to support claims assessments.
4. Collaboration:
   Work closely with the Claims Manager and other team members to ensure alignment and consistency in claims handling.
   Coordinate with underwriters, legal teams, and external service providers to facilitate the resolution of complex claims.
5. Compliance and Reporting:
   Ensure that all claims handling practices adhere to Treating Customers Fairly (TCF) principles, regulatory requirements, and internal policies.
   Prepare and submit claims reports to the Claims Manager, highlighting trends, risks, and opportunities for process improvement.

Minimum Required Qualifications:

1. Matric Certificate.
2. RE5.
3. NQF5 Wealth Management.
4. A tertiary qualification in Insurance, Business Administration, or a related field is advantageous.
5. Relevant certifications in life insurance or claims processing are preferred.

Minimum Required Experience:

1. At least 2 years of experience in life insurance claims processing or a related role.
2. Experience in the insurance or financial services industry is essential.

Required Skills & Attributes:

1. Strong knowledge of life insurance products and claims processes.
2. Excellent communication and interpersonal skills, with the ability to engage empathetically with clients and beneficiaries.
3. Proficiency in Microsoft Office and claims management systems.
4. High level of attention to detail and accuracy.
5. Strong analytical and problem-solving abilities.
6. Ability to handle sensitive information with confidentiality and professionalism.
7. Ability to work effectively under pressure and manage multiple tasks simultaneously.