Health Claims Examiner
2 months ago
About Diligenta
Diligenta is a leading provider of life and pensions administration services, committed to delivering exceptional customer experiences and transforming client operations.
Job Summary
We are seeking a skilled Claims Assessor to join our operations team, responsible for managing individual protection claims from initial notification to final settlement.
Key Responsibilities
- Examine and evaluate insurance claims for accuracy, completeness, and eligibility based on policy terms and conditions.
- Make informed decisions regarding the approval or denial of claims based on gathered evidence and policy guidelines.
- Investigate and verify the legitimacy of claims through document analysis, medical reports, and other relevant information.
- Liaise with medical professionals, legal advisors, and other third parties to obtain required documents and expert opinions.
- Maintain detailed and accurate records of all claim assessments, decisions, and communications.
- Ensure all claim files are up-to-date and comply with company policies and regulatory requirements.
- Offer exceptional customer service by addressing queries, concerns, and appeals from claimants promptly and professionally.
Requirements
- Previous experience in claims assessment or a related field within the insurance industry.
- Experience in handling life insurance, health insurance, or pension claims is highly desirable.
- Strong analytical and critical thinking abilities to evaluate complex information and make sound decisions.
- Proficiency in analysing medical reports, financial documents, and other relevant data.
- High level of accuracy and thoroughness in reviewing claims and documentation.
- Ability to identify discrepancies and potential fraud.
- Excellent verbal and written communication skills for interacting with claimants, colleagues, and third parties.
- Ability to explain complex information clearly and concisely.
- Strong commitment to providing exceptional customer service.
- Empathy and patience in handling sensitive situations and distressed claimants.
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