Talent Pool: Claims Assessor MMH261030-4

Momentum; Cape Town; Presencial; ZAR 240.000 - 360.000; Jornada completa

Descripción de la vacante

Momentum in Cape Town seeks a claims processor to assess and manage disability, dread disease and income disability claims with a medical component. You will partner with stakeholders to improve the client experience and support policy processes while maintaining accurate records and complying with legislation.

Leveraging knowledge of claims rules and processing systems, you will contribute to continuous improvement and provide timely reporting for management and clients.

Formación

• Grade 12 or equivalent essential.
• 1-2 years experience in processing claims essential.
• Knowledge of relevant legislation and industry regulations.
• Knowledge of the claims assessment process (paper and EDI).

Responsabilidades

• Assess, review and manage disability, dread disease and income disability claims with a medical component per SLAs.
• Collaborate with stakeholders to improve claims assessment and client experience.
• Contribute to procedures and processes for quality and service improvement.
• Keep accurate records of all claims assessed per legislation and business expectations.
• Stay updated on regulatory changes affecting claims processing.
• Identify opportunities for cost reduction, quality improvement and systems enhancements.

Conocimientos

Claims processing

Regulatory knowledge

Stakeholder collaboration

Educación

Grade 12

Relevant degree/qualification

Herramientas

EDI systems

Claims operating systems

Descripción del empleo

Role Purpose

Assess, review and manage living benefit claims, in accordance with relevant legislation and company policy, adhering to service level agreements and meeting client and business expectations.

Requirements

• Grade 12 or equivalent qualification - essential
• Relevant degree or qualification - desirable
• 1-2 years experience in processing claims - essential
• Experience in assessing of relevant 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

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.

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