Claims Assessor Mmh240415-3

Momentum Metropolitan Holdings Limited; Gauteng; On-site; ZAR 300,000 - 450,000; Full time

Job summary

A major company in the insurance sector seeks a Claims Assessor to provide top-notch claims assessment for living benefits. This role involves evaluating claims for critical illness and disability benefits, supporting team members, and enhancing methodologies to ensure efficient service delivery while complying with regulations and best practices.

Qualifications

• 1-3 years experience in life insurance claims.
• Relevant insurance knowledge and applicable regulatory requirements.
• Experience with retail protection market products.

Responsibilities

• Execute claims assessment for living benefits.
• Approve or decline claims submissions.
• Collaborate with stakeholders to enhance client experience.

Skills

Claims assessment

Risk management

Communication

Education

B. / BSc. in Occupational Therapy, Physiotherapy, Psychology, or related health sciences

Job description

Company Overview

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations.

We help people grow their savings, protect what matters to them, and invest for the future.

We help companies and organisations care for and reward their employees and members.

Through our own network of advisers or via independent brokers and utilizing new platforms, Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.

Visit us at [company website].

Disclaimer: As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

To be part of a team that provides market-leading claims assessment capability for living benefits (critical illness, income, and disability benefits).

This includes specialising in income disability, lump sum disability, critical illness, and case management for living benefits, and completing quality industry assessments within the required service levels.

Minimum Requirements

• B. / BSc. in Occupational Therapy, Physiotherapy, Psychology, or qualified Registered Nurse or other health sciences related degree considered appropriate.
• 1-3 years experience in life insurance claims.
• Relevant insurance knowledge, applicable regulatory requirements, and legislations (beneficial).
• Experience of general retail protection market product offerings (beneficial).

Responsibilities

• Execute claims assessment methodology across Critical Illness, Income Protection, and Lump Sum Disability benefit lines.
• Approve or decline claim submissions within company guidelines without supervision.
• Support team members with best practice techniques and medical knowledge sharing.
• Select and accept major risks on behalf of the company, evaluating proposals.
• Assist in improving risk management within the living benefits assessment area.
• Develop and apply new claims assessment methodologies, incorporating industry and company best practices, research, and technology.
• Ensure consistent application of established practices in claims assessment.
• Collaborate with internal and external stakeholders to improve claims assessment and client experience.
• Ensure assessment methodology complies with legislation and best practices to optimize service delivery.
• Stay familiar with regulatory frameworks, court decisions, and determinations that may impact claims processing.
• Identify risks and opportunities to prevent fraud and ensure quality work.
• Build and maintain relationships with internal stakeholders responsible for primary clients.
• Follow internal client service practices to build rewarding relationships and deliver exceptional service.
• Contribute to a culture of client service excellence and incorporate feedback into business process improvements.
• Promote a positive work climate and culture among employees.