Disability Claims Dispute Consultant
2 weeks ago
Sanlam Corporate forms part of Sanlam Life and Savings Cluster which offers retail and corporate life insurance, health and investment products in South Africa.
Our vision is to be the preferred partner to Corporate and Public Sector by providing an awesome client experience and comprehensive solutions that enable the financial resilience and prosperity of those entities and their employees.
We tap intoover100yearsof expertise to provide cost-effective Employee Benefits and Healthcare Solutions that enable financial confidence for our members.We enable our clients to make better retirement and risk decisions today through determined and passionate thought leadership and best-in-class people, innovative products and proven processes all designed to help people live a better life tomorrow.
We believe in creating and cultivating a positive, energised working environment that gives every individual the opportunity to achieve success by embracing diversity and growing our talent.
We do this through living our values of having the courage to be bold, care, collaboration and an intolerance for mediocrity.
We're all about building strong, lasting relationships with our employees. We know that you have hopes for your future-your career, your personal development and of achieving awesome. The overall purpose of the roleReassessing disputed/appealed disability claims taking into account the medical/clinical information, the job requirements and the policy contract. Responding to complaints within specified timeframes. Providing detailed feedback to the complainant or relevant regulatory body. Working closely with the administrative team and collaborating with internal stakeholders to ensure accurate information and feedback. Managing and monitoring complaints and reporting to the Complaints Office. What will you do?
Key responsibilities:
Reassess medical and contractual validity of disability claims that are appealed or disputed.
In depth investigation of the complaint/appeal/dispute.
Communication (telephonic, in person or written) with the complainant, regulatory body (e.g. OLTI) or other stakeholders.
Communicate and liaise with internal and external clients, claimants, medical professions, service providers and intermediaries, as necessary or required by the case.
Present business decision cases to Senior Management and SGR or Core Operations leadership.Monitor and manage complaints (e.g CEO, Hello Peter, etc) within the relevant SLA.
Administration such as recordkeeping, summarising information, communication to clients and updating relevant systems.
Ensure that outcome of appealed/disputed claim is followed through or executed by the relevant team/department.
Feedback to the team on dispute claims and findings/trends.
Provide monthly stats to Senior Manager.
Manage complaints mailbox and keep record of complaints. Provide monthly update to the SC Complaints team.
What will make you successful in this role?
B.Sc. Occupational Therapy or Physiotherapy of qualified Nursing Sister (relevant registration not mandatory)
At least 5 years experience in disability claims assessment (employee benefits experience is preferred)
Computer proficient with Microsoft Office Excel, Word, Powerpoint, Word and Outlook Knowledge and Skills
Excellent interpersonal skills
Good verbal and written communication skills
Strong analytical skills
Well executed report writing ability
Ability to find solutions related to the probable cause
Comprehensive understanding of occupational risk and demands
Understanding of medical conditions and their implications on functional ability and work competence Personal Qualities Flexible and Adaptable - Rebounds from setbacks and adversity when facing difficult situations.
Courage - Steps up to address difficult issues, saying what needs to be said. Manages Complexity - Demonstrated ability and proven record in making complex decisions. Ensures Accountability - Holds self and others accountable to meet commitments.Plans and Aligns - Plans and prioritises work to meet commitments aligned to organisational goals Core Competencies Cultivates Innovation by creating new and better ways for the organisation to be successful.
Client Focus - Building strong customer relationships and delivering customer-centric solutions. Drives Results - Consistently achieving results and meets deadlines, even under tough circumstances. Collaborates - Building partnerships and working collaboratively with others to meet shared objectives. Resilience - Rebounding from setbacks and adversity when facing difficult situations. Build a successful career with us Turnaround time Our commitment to transformationThe Sanlam Group is committed to transformation and embracing diversity and our employment equity plan and targets will be considered as part of the recruitment process.
This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive-
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