Team Leader - Disability Claims Assessment

Discovery Limited; Johannesburg; On-site; ZAR 600,000 - 800,000; Full time

Job summary

A leading employee benefits provider in Johannesburg seeks an experienced professional to manage disability claims and lead a dedicated team. This role requires strong clinical reasoning, exceptional decision-making skills, and at least 5 years of experience in insurance. You will enhance processes, advocate company values, and ensure the highest standard of client service. Competitive compensation and growth opportunities offered.

Qualifications

• Medical Degree or related qualification required.
• 5+ years of insurance experience.
• Must have 2-3 years of clinical experience.

Responsibilities

• Manage disability claims from identification to resolution.
• Lead the disability claims team and foster a positive work environment.
• Advocate for company values and customer care best practices.

Skills

Clinical reasoning skills

Decision making skills

Verbal and written communication skills

Problem solving skills

Resilience

Attention to detail

Time-Management and Organizational Skills

Outstanding customer service skills

People leadership skills

Education

Medical Degree Allied Professional degree

Diploma in Vocational Rehabilitation

2-3 years clinical experience

5 or more years Insurance experience

3 years leadership experience

Job description

About Discovery

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Discovery Corporate & Employee Benefits

Discovery Corporate and Employee Benefits is the first and only employee benefits provider to be shaping employee behavior, creating healthier and wealthier workforces. It is an exciting business to be in as we reimagine the way retirement savings and life insurance is brought to companies and employees.

Key Purpose of the role

The primary function of this role is comprised of two aspects, the first is to a lesser extent is to identify, assess and manage claims with internal and external stakeholders within the Disability Management process from Early Identification through the lifecycle of the claim. The second and more key role is to take on key reporting, people leadership and project leadership tasks within the Disability Claims Team. A key purpose is to add value to current processes by identifying gaps, developing processes and proposing innovative recommendations that will impact efficiencies and the quality of work produced and serve as a subject matter expert within the team. The ultimate goal of the role is to manage the disability claims experience through innovative and efficient claim management as well as develop people leadership skills and functional leadership skills providing key support to the management of the team as a whole.

Areas of responsibility may include but not limited to

• Independently assess all benefits and a key player in determining the direction and outcome of the disability portfolio. Independently provide opinions, assess, and manage disability claims within the Disability Management process, with the intention of holistically managing the claim process and experience for clients (25% of role).
• Independent discussion and presentation of cases to the reinsurer and/or Chief Medical Officer. Actively participate in claims committee/ legal claims/ forensics
  • Increase in authorization limit: SIB 500 000.00, ICB 40 000.00, CD 500 000.00)
  • Claims Type assessment and consultation:
    • SIB, ICB,CD and Technically Complex claims,
    • Appeals
    • Escalated claims,
    • Long term claim decisions
    • Ex Gratia claims and discussions,
    • Lead claims collab debates
• Ensure and co-ordinate recruitment of effective, skilled, and knowledgeable staff. Teach, train, coach, supervise, counsel, empower etc. staff daily on disability matters and processes, developing trends and breaking news affecting claims handling.
• Advocate the vision, the purpose, and the core values of the company to the team. Appraise staff and manage their performance on a regular basis. Assist in the development of Business Continuity Plans to be affected in case of emergencies.
• Customer Care Role: Ensure that the best quality service is provided to the clients. Developing, monitoring, and ensuring that staff adheres to service level agreements, best business practices, standard operating procedures, policy guides, legislations, audit and compliance recommendations, quality assurance, authority, and referral limits etc. Use Customer Perception surveys to measure the customer satisfaction.
• Manage broker perception through resolution of queries Building effective relationships with internal and external parties.
• Managing Complaints and Escalations of clients to ensure high levels of service are adhered to.
• Educational Role and Relationships Management Role: Serve as a subject matter expert on disability claims and be a source of knowledge and advise to internal and external clients. Educate new and existing clients on disability products, processes, and requirements. Education is extended to our employees, Servicing Consultants, Business Consultants, Discovery Group leaders and HR practitioners etc.
• Product and system enhancements Role - Take an active role in developing better disability claim assessment and management systems, processes, products, and guidelines. Provide input/suggestion aiming at creating profitable products that will meet the needs of the target market and products that are update and relevant to our medico-legal and social and market demands, and to maintain and sustain our competitive advantage. Add value to current processes by identifying gaps, developing processes, and proposing innovative recommendations that will impact efficiencies, and the quality of work produced.
• Support with key reporting, people leadership and project leadership tasks within the disability team.
• Monthly stats analysis and identifying gaps and operation priorities hat need to be addressed
• Log QCs/Jira on an ad hoc basis.
• Log IQS breaches on Paradigm.
• Development and support of project work to improve processes.

Personal Attributes and Skills

• Clinical reasoning skills
• Decision making skills
• V erbal and written communication skills
• Problem solving skills
• Resilience
• Self-starter with a high attention to detail and be able to multi-task
• Extremely adaptable to change
• Ability to function well in a high-performance environment with significant accountability.
• Time-Management and Organizational Skills
• Outstanding customer service skills
• People leadership skills including coaching and mentoring
• Presentation skills (development and presenting)

Education and Experience

• Medical Degree Allied Professional degree through a register University: advantageous courses are Occupational Therapy, Physiotherapy, Speech Therapy, Audiology or related professions.
• Additional courses recommended but not required: Diploma in Vocational Rehabilitation
• 2-3 years clinical experience outside of community service
• 5 or more years Insurance experience
• 3 years leadership experience (insurance or clinical) (External)

EMPLOYMENT EQUITY The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.