Claims Adjudication Officer

About the role

We are seeking a Claims Adjudication Officer to join our Insurance Operations Services – Claims Management team. The role involves administering death and living benefit claims with efficiency, empathy and professionalism.

Key responsibilities

• Conduct client interviews and advise on required documentation for death and living benefit claims.
• Create and maintain claim files, ensuring all documents are complete and authentic.
• Update the claims system with appropriate status and termination details.
• Prepare and submit claim files exceeding approval limits to the Assistant Manager.
• Follow up on outstanding claims, investigate inquiries and respond to clients.
• Input data to generate cheques for claim proceeds and process discharges.
• Provide guidance to beneficiaries of orphan policies regarding reinvestment options.
• Perform other related duties as assigned.

Required profile

• Bachelor’s degree in Business, Management, Nursing or a related discipline.
• Successful completion of LOMA 1 and 2 certifications.
• Minimum three years’ experience in the insurance industry.
• Strong client service orientation and teamwork abilities.
• Effective oral and written communication skills.
• Good knowledge of the company’s product portfolio and basic medical terminology.

Required skills

• Proficiency with spreadsheet and word processing software.
• Experience using the CAPSIL claims management system.