Job Description

Closing Date 2024/01/29
Reference Number MMH230109-4
Job Title Disability Claims Assessor
Position Type Permanent
Role Family Client Services
Cluster Momentum Corporate
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Cape Town and Centurion
Introduction

Receives disability claims and assesses payment of benefits in accordance with the rules of the fund and in applying clinical expertise.
Role Purpose

Receives disability claims and assesses payment of benefits in accordance with the rules of the fund and in applying clinical expertise.
Requirements

• BOT (Bachelor of Arts Occupational Therapy) / BSc.OT degree or BSc Physiotherapy.

• Registration with the HPCSA as OT, or Physio

• Minimum 1-year relevant experience.

Additional Requirements

• Role requires travelling to clients, code B license and own vehicle required.

• Understanding of medical conditions and their implication on functional ability, especially relating to job requirements.

• Understanding and knowledge of the group insurance Industry.

• Appreciation of future trends within Employee Benefits.

• Knowledge of current legislation relevant to the industry.

Duties & Responsibilities

INTERNAL PROCESS

• Develop effective relationships with stakeholders at all levels of the organization, including 3rd parties and service providers.

• Monitor customer delivery constraints and escalate exceptions to management.

• Ensure Service Level Agreements are met.

• Identify risks to the company and escalate accordingly.

• Monitor claims received to ensure that duplication does not occur resulting in financial loss to the company.

• Drive and support effective teamwork within the department.

• Engage in appropriate training interventions to promote own professional development.

• Ensure to demonstrate the company's values on a daily basis.

• Adhere to organizational best practice and legislative requirements.

• Ensure effective claims management service delivery and support.

• Perform an efficient and accurate administrative function.

• Identify and investigate all pre-existing conditions.

• Validate all claims, and ensure they are correctly completed and indexed, and no duplication and whether pre-approval has been obtained.

• Adhere to policies and procedures and take corrective action where necessary.

• Ensure all risks are mitigated and escalated where necessary.

CLIENT

• Provide authoritative, expertise and advice 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.

• Managing the client relationship, attend client meetings and facilitate training in respect of claims processes

• 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 stakeholders

• 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

• 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

• Business Acumen

• Client Commitment

• Drive for Results

• Leads Change and Innovation

• Impact and Influence

• Collaboration and teamwork

• Self-Awareness and Insight

• Diversity and Inclusiveness

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Momentum Metropolitan