Talent Pool Claims Assessor

Momentum Metropolitan Holdings Limited; Centurion; On-site; ZAR 240,000 - 360,000; Full time

Job summary

Momentum Metropolitan Holdings Limited is seeking a claims assessor to review and manage disability, dread disease and income disability claims in line with policy and SLAs.

The role requires 1-2 years of claims processing experience, knowledge of insurance regulations, and the ability to work with relevant claims systems to improve accuracy and service delivery.

Qualifications

• 1-2 years experience in processing claims.
• Experience in assessing relevant insurance or medical aid claims (Desirable).
• Knowledge of relevant legislation and industry regulations.
• Knowledge of the claims assessment process (paper and/or EDI).
• Knowledge of the relevant scheme or product rules.

Responsibilities

• Assess, review and manage disability, dread disease and income disability claims in line with SLAs.
• Collaborate with stakeholders to improve claims assessment and client experience.
• Develop procedures and processes within area of specialization for quality and service improvement.
• Keep accurate records of all claims assessed in line with legislation and expectations.
• Stay updated on regulatory frameworks and court decisions impacting claims processing.
• Support continuous improvement and cost reduction in claims decisions and systems.
• Provide testing support for claims systems to improve quality and efficiency.
• Input into claims policies, forms and documentation to ensure risk management.

Skills

Claims processing

Insurance knowledge

Regulatory knowledge

Education

Grade 12 or equivalent

Relevant degree or qualification

Job description

Through our client-facing brands Momentum Group, 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.

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

QUALIFICANTIONS

• Relevant degree or qualification (Desirable).
• Grade 12 or equivalent qualification (Essential).

EXPERIENCE

• 1-2 years experience in processing claims.
• Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (Desirable).

KNOWLEDGE

• 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 & Responsibilities

INTERNAL PROCESS

• 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.

CLIENT

• Provide authoritative expertise to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

PEOPLE

• Develop and maintain productive and collaborative working relationships with peers and stakeholder.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas.
• Take ownership for driving career development.

FINANCE

• Contribute to the financial planning process within area.
• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.