Underwriter

We are looking to for an underwriter to evaluate all claims lodged with AVBOB, regarding life, disability and funeral insurance and determine their validity. Where required, investigate claims to mitigate against fraudulent activities.

You will be working for a company that is over 100 years old with strong values. In return for your services, you will be paid a competitive remuneration package. You will be working for an organization that values employee development and rewards excellent performance.

YOUR RESPONSIBILITIES WILL INCLUDE THE FOLLOWING:

Medical underwriting: Investigating the medical history of claimants/the deceased

• Underwriting of all death, disability/debility and critical illness claims according to Re- insurer guidelines, where applicable.
• Investigate non-disclosure of medical history of the deceased/claimants.
• Requesting of documents such as medical certificates from the medical practitioners of the claimant/ deceased indicating the medical history of the claimant/deceased.
• Request the sick leave records from the employer of the claimant/deceased for the mentioned period.
• Forward information on suspicious or questionable claims to Re- insurer for a ruling.
• Consult with clients, SAPS, medical practitioners, and hospital personnel to obtain relevant information regarding claims. Although some of the information is not always easily obtainable, it remains imperative to proceed with the investigation.
• Decide on whether to decline or accept claims after the contents of all the evidence have been evaluated.
• Make recommendations for the payment of controversial claims after the contents of all the evidence have been evaluated.
• Adherence to all regulatory requirements, for example the FSCA’s rules and principles, Data Protection Act (Protection of Personal Information -POPIA) and Money Laundering regulations. Awareness of the Group’s policies and procedures and the regulations relevant to your role.
• Consistently demonstrate your understanding of how the principle of the TCF and the underlying six TCF outcomes impacts your role and is embedded in the culture of AVBOB.
• Utilize the Life and claims register to investigate claims.

Determine the validity of claims

• Be well informed about the conditions of all life, disability, and funeral policies to be able to indicate what benefits are payable under the different policies.
• Establish the authenticity of documents received by ensuring that copies of the required documents are legible and certified where applicable. Evaluate the contents of these documents to determine the authenticity of the relevant claim.
• Identify risks, monitor and measuring risk against risk appetite, risk mitigation strategies, and risk reporting.
• Keep track of cases referred to in the Forensics department and ensure responses not received as per stipulated processes and guidelines are followed up.
• Utilize information from Verification of Personal information – VOPD, and the life and claims register to validate claims.
• Ensure suspected fraud cases as well as those with high-risk scores according to stipulated Risk scoring guidelines are referred to Forensic department.
• Identify and keep record of syndicates involved in fraudulent claims as they will continue to lodge such claims with AVBOB.

Productivity

• Manage the daily underwriting tasks in the department to ensure optimization of claims turnaround times.
• Ensure optimal productivity level is achieved through management of daily tasks.
• Ensure the number of outstanding claims are reduced and standards are maintained.
• Ensure the department Customer Satisfaction rating levels are maintained at required levels.
• Perform to ensure the departments’ month end turn around metrics is reached.
• Ensure set underwriting daily production stats are reached.

Responding to complaints and enquiries

• Respond to complaints and enquiries relating to fraud cases and this requires that caution be exercised whenever answers are provided or action steps implemented as the wrong approach will be detrimental to AVBOB.
• The incumbent is to be well informed regarding all problematic cases, as the information might be required when court hearings are attended.
• Investigate and provide feedback on all complaints received.
• Notify clients regularly as to the status of the claim if claim is referred to internal or external Forensics.

Writing of reports regarding investigations of fraudulent claims

• Preparation of a monthly report of all cases on which fraud has been detected and where investigations are being done.
• The reports are discussed at management meetings, and they will issue instructions on how they would like certain problem issues to be addressed. The incumbent is to ensure the instructions are implemented.
• Make recommendations on preventative measures that would result in the improvement of the current systems.
• Prepare ad hoc reports on request regarding for instance the number of fraudulent cases investigated, the number successfully resolved and the number still outstanding.

Provide line functional training to junior members and attend meetings

• Develop, train and keep clerks in the department informed about all the documents that are required to finalise claims lodged regarding life, disability and funeral policies.
• Sharing of information with colleagues (eg when we can use VOPD report to replace unclear death certificate).

• Grade 12
• National Certificate/Diploma in Underwriting
• 3 Years or more relevant experience of long-term insurance underwriting
• Nursing experience or a strong medical background will be considered an advantage
• Knowledge of ASISA codes and standards relating to long term insurance

Equity Statement: We are committed to Employment Equity when recruiting internally and externally. It is company policy to promote from within wherever possible. “Preference will be given to suitably qualified individuals from previously disadvantaged groups in South Africa.”