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Claims AssessorMomentum Metropolitan Holdings

GautengSouth Africa
a year0 Applicants
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job description - Claims Assessor

  • 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.
  • Minimum of 1-2 years experience in processing claims.
  • Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (desirable).
  • Analytical skills.
  • Attention to detail.
  • Interpersonal skills.
  • Problem solving skills.
  • 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    

  • 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 clients 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. 
  • 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.
  • 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. 
  • 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.

Competencies    

  • Examining Information
  • Documenting Facts
  • Interpreting Data
  • Interacting with People
  • Making Decisions
  • Meeting Timescales
  • Managing Tasks 
  • Communication skills
  • Service orientation
  • Prioritisation skills
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About the company

Momentum Metropolitan Holdings is listed on the Johannesburg Stock Exchange, as a South African-based financial service provider.

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