Claims Assessor Temp MMH260410-7

Momentum; Sandton; On-site; ZAR 240,000 - 360,000; Full time

Job summary

Momentum in Sandton seeks a claims assessor to evaluate disability, dread disease and income disability claims with medical components, aligned to service level agreements and policy.

The role requires collaborating with stakeholders to improve the client experience, refining procedures, maintaining records, and staying up-to-date with regulatory changes affecting claims handling.

Responsibilities

• Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level agreements.
• Partner and collaborate with relevant stakeholders, to improve claims assessment and the client's claim experience.
• Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
• Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation.
• Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
• Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
• Give input into and review claims policies, practices, forms and documentation to ensure that risk management standards are met and aligned to relevant product changes and legislative updates.
• Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required.

Job description

Role Purpose

The successful incumbent will be responsible for assessing, reviewing, and managing living benefit claims in accordance with relevant legislation and company policy, while adhering to Service Level Agreements and meeting client and business expectations.

Requirements

• Relevant degree or qualification (Desirable)
• Grade 12 or equivalent qualification (Essential)
• 1-2 years experience in processing claims
• Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (Desirable)
• Knowledge of relevant legislation and industry regulations
• Knowledge of the claims assessment process (paper and EDI)
• Knowledge of the relevant scheme or product rules
• Knowledge of relevant claims operating systems and tools

Duties and Responsibilities

• Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level agreements.
• Partner and collaborate with relevant stakeholders, to improve claims assessment and the client's claim experience.
• Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
• Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation.
• Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
• Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
• Give input into and review claims policies, practices, forms and documentation to ensure that risk management standards are met and aligned to relevant product changes and legislative updates.
• Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required.

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