Senior Firearm Compliance Officer

3 weeks ago


Benoni, Gauteng, South Africa Bidvest Protea Coin Full time

Introduction

Momentum Health Solutions is a provider of sustainable, integrated health solutions that meet the diverse needs of clients and maximize lifetime client value. We foster a culture of innovation and create value by applying unique insights to achieve specific outcomes using defined Health capabilities.

Role Purpose

The role involves assessing, reviewing, and managing living benefit claims in accordance with relevant legislation and company policy, while adhering to service level agreements and meeting client and business expectations.

Requirements

  • A Grade 12 or equivalent qualification
  • 1-2 years of experience in processing claims
  • Experience in assessing relevant insurance or medical aid claims (paper and/or EDI)
  • A relevant degree or qualification
  • 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

INTERNAL PROCESS

  • Assess, review, and manage disability, dread disease, and income disability claims, as well as other claims requiring a medical assessment component, in line with service level agreements.
  • Partner with relevant stakeholders to improve claims assessment and client claim experiences.
  • Contribute to the development of procedures and processes within the area of specialization for continued quality and service improvement.
  • Maintain accurate records of all claims assessed in accordance with business expectations and relevant legislation.
  • Stay up-to-date on relevant regulatory frameworks, insurance-related court decisions, and determinations by regulatory bodies that could impact how claims are processed or handled.
  • Support continuous improvement efforts through identifying opportunities, cost reduction, improving the quality of claims decisions, and system enhancements.
  • Provide insight, knowledge, assistance, and testing support as needed for the development and maintenance of claims systems to improve quality and efficiency.
  • Contribute to and review claims policies, practices, forms, and documentation to ensure risk management standards are met and aligned with relevant product changes and legislative updates.
  • Provide accurate and timely reporting, analysis, and insights on claims assessed as required.

CLIENT

  • 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 to ensure client expectations are managed.
  • Make recommendations to improve client service and fair treatment of clients within the area of responsibility.
  • Participate in and contribute to a culture that builds rewarding relationships, facilitates feedback, and provides exceptional client service.

PEOPLE

  • Develop and maintain productive and collaborative working relationships with peers and stakeholders.
  • 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 financial planning within the area.
  • Identify opportunities to enhance cost-effectiveness and increase operational efficiency.
  • Manage financial and other company resources under control with due respect.
  • Provide input into risk identification processes and communicate recommendations in the appropriate forum.

Competencies

  • Examining Information
  • Interacting with People
  • Managing Tasks
  • Documenting Facts
  • Making Decisions
  • Producing Output
  • Interpreting Data
  • Meeting Timescales


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