Claims Adjudicator

Responsible for the adjudication of risk claims: (death claims, disability/waiver claims, critical Illness, Accidental death/ dismemberment).  He/ She is responsible for the review and authorization of simple claims and any others assigned by the Senior Adjudicator for training purposes in line with the established best practice, company guidelines and authorization limits and based on expert advice received from relevant experts.

KEY ACCOUNTABILITIES

1. Assessment and Determination of simple and Group Life risk claims within the free cover limit (Death, Critical Illness claims, Disability Income and Waiver of Premium as well as Accidental Indemnity Rider and documentation of key information supporting the decision
2. Recommend the use of expert advice from Utilize expert opinion from the following where applicable to assist in the determination of the claims. These include but are not limited to the Chief Medical Officer or other medical professionals, Chief Financial Officer, Chief Underwriter, Legal Officer and investigators or any other expert.
3. Refer claims that may require special consideration to the Senior Adjudicator for further referral to the Claims Committee including the relevant documentation and a summary of the rational for referral, the recommended decision and actioning the outcomes of the meeting.
4. Confer with the Senior Adjudicator for guidance.
5. Verify and authorize claims payments and approve Payment Request Vouchers for Claims payments and refunds within authorized limits.

 

EDUCATION & QUALIFICATIONS

 

• A First Degree in Business, Insurance or relevant field from a recognized tertiary educational institution
• 5 CXC ‘O’ Levels, including Mathematics and English

• 2 A’ Level/ CAPE passes

• LOMA diploma – FLMI / ACS

 

EXPERIENCE

At least 2-3 years’ experience in a Customer Service / Underwriting / Claims Environment in the financial services industry. In depth knowledge of Products and Contracts of TATIL Life