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Specialised Assessor

Vacancy Details

Reference No.



A reputable insurance organisation is currently seeking an individual to assume the role of Specialised Assessor. The successful incumbent will be responsible for the daily administration and support of all managed healthcare services provided within a self-administered medical environment. This includes liaising with members, and healthcare professionals, delivering exceptional customer service.


  • Action the departments overall work plans and targets with respect to specialised assessing queries and complaints, assessors, interventions and reversals.
  • Review and assess queries to ensure accurate resolutions in line with the organisation’ rules.
  • Review and validate information on all medical requests in the department to ensure that there is no missing or incomplete information.
  • Follow up and ensure closure on any outstanding queries.
  • Ensure operational alignment to the ISO processes, Standard Operating Procedures and organisation’ rules, policies and procedures.
  • Ensure that all queries are actioned correctly to ensure that the correct claims are paid against the correct code.
  • Adhere to relevant laws, regulations, policies and procedures that provide the internal controls in executing the query process.
  • Identify gaps in processes, analyse and improve where necessary to increase speed, quality and gain efficiencies within the department.
  • Ensure excellent service levels to all stakeholders, by ensuring that claims are paid timeously and accurately.


  • Matric.
  • 3 years’ experience in the Medical aid industry.
  • 2 years Medical aid Support Services or Contact Centre experience.
  • In depth knowledge of business processes would be an added advantage.

Kindly note, if you have not heard from us within two weeks of your application please consider it unsuccessful.

Position Type


Work Level



Market Related



Salary Type



Cost To Company

Affirmative Action


Geographic Location

Gauteng - JHB North