Claims Assessor

Reference Number MMH240415-3

Job Title Claims Assessor

Position Type Permanent

Role Family Client Services

Cluster Momentum Life

Remote Opportunity Some of the time

Location – Country South Africa

Location – Province Gauteng

Location – Town / City Centurion

Introduction

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities and businesses. Visit us at http://www.momentummetropolitan.co.za

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

Role Purpose

To be part of a team that provides market leading claims assessment capability for living benefits (critical illness, income and disability benefits). This will include specialising in income disability, lump sum disability,critical illness and case management for living benefits, the completion of quality industry assessments within the required service levels.

Requirements

• B./BSc. Occupational Therapy, Physiotherapy or Psychology or Qualified Registered Nurse or other health sciences related degree considered appropriate.
• 1-3 Experience in life insurance claims.
• Relevant insurance knowledge, applicable regulatory requirements and legislations (beneficial).
• Experience of general retail protection market product offerings (beneficial)

Duties & Responsibilities

• Execution of the claims assessment methodology across Critical Illness, Income Protection and Lump Sum Disability benefit lines.
• Approves or declines claim submissions without supervision within company guidelines.
• Support team members with best practice techniques,medical practice through knowledge sharing.
• Selects and accepts major risks on behalf of the company, evaluating proposals rather than mechanistic assessment.
• Assist with the overall improvement of risk management within the living benefits assessment area.
• Continuous development and application to ensure successful execution of the new claims assessment methodology,including: Current best industry and company practices. Claims research. Technological enablers.
• Embedding and applying established practices to ensure consistent application of these in the claims assessment environment. To partner and collaborate with both internal and external stakeholders, not limited to product development,underwriting, CMO, reinsurance partners to improve claims assessment and client experience.
• Ensure that assessment methodology and execution is in line with legislation and best practices within the financial management field in order to optimise the claims assessment service offering and deliver.
• Familiar with the regulatory framework, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Risk opportunity identification to prevent fraud and to deliver quality work.
• Build and maintain relationships with internal stakeholders responsible for the primary client.
• Build and maintain relationships with internal stakeholders responsible for the primary client and advisor interactions (claims consultants).
• Follow internal client service practices which build rewarding relationships and enables exceptional client service
• Contribute to a client service excellence culture which builds enduring relationships and allows team to provide exceptional client service.
• Incorporate internal assessment feedback into the enhancement of daily business processes and management operating systems.
• Act in a way that allows for a positive work climate and culture with fellow employees.

Competencies

• Business acumen.
• Client / Stakeholdercommitment.
• Assertiveness.
• Drive for results.
• Diversity and inclusiveness.
• Collaboration and team work.
• Impact and influence.
• Results and solution focused.
• Self-awareness and insight.
• Diversity and inclusiveness.