Job Description

Introduction

Momentum Health, an entity of Momentum Group delivers sustainable,integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation,and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

To manage and maintain claims processing service levels in the Claims Team to exceed client expectations.

Requirements

Matric or equivalent - (essential)
Knowledge of the medical scheme administation business essential
3 - 4 years' experience in a Medical Scheme Administration Claims environment - (essential)
1 - 2 years' People management experience - (essential)
Relevant tertiary qualification would be preferred.

Knowledge

Sound knowledge of Medical Scheme claims policies, procedures and processes
Computer Literacy - MS Office: Work, Excel, Outlook and other business-specific software
Knowledge of performance metrics

Duties & Responsibilities

INTERNAL PROCESS

Manage, monitor and control the Claims team's delivery on Service Level Agreements made with clients.
Manage, monitor and control the team's execution of client claims and queries.
Act as an escalation point to assist Claims team addressing client queries.
Ensure team's adherence to correct procedure when following up on queries.
Analyse the Claims Administration processes and identify opportunities for improvements; implement improvements within the Claims team.
Identify and report process and system failures and enhancements to improve client experience.
Investigate client queries within the agreed service level and ensure that client receives timeous feedback.
Escalate client queries to the relevant department or stakeholder.


CLIENT



Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate after sales services.
Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets.
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.
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



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

Adopting Practical Approaches
Making Decisions
Upholding Standards
Generating Ideas
Directing People
Producing Output
Developing Strategies
Empowering Individuals
* Time management