Administrator: Mva Recoveries

2 weeks ago

Cape Town, South Africa Health Solutions Full time

**Introduction**

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings 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.

**Role Purpose**

Ensure that claims are lodged against the road accident fund for treatment of injuries sustained during a motor vehicle accident and that the scheme is reimbursed the costs of such treatment on finalisation of the claims

**Requirements**:

- Matric
- Minimum of 1 to 2 years relevant experience
- Experience in medical claims assessing
- Experience in identifying whether a member is able to obtain compensation from another party for treatment of injuries
- Experience in or at least knowledge of procedures involved in lodging claims against responsible third parties
- Ability to draft effective correspondence in both English and Afrikaans
- Report writing skills
- MS Excel and MS Word Skills

**Duties & Responsibilities**

**Internal Process**
- Identifying possible third party claims
- Sourcing possible MVA cases for investigation to establish merits
- Obtain an undertaking, identifying medical treatment due to injuries
- Forward a request to the member/attorney for the respective scheme's undertaking to be completed and signed once it has been confirmed that there is a valid claim against the Road Accident Fund
- Obtaining copies of accounts for medical treatment from the various Medical Practises
- Submitting Medical Claims Schedules to attorneys for lodging Past Medical Claims with the RAF
- Dealing with telephone and correspondence queries from members, attorneys and the RAF
- Archive all correspondence on member's correspondence file
- Follow up all existing third party claims and ensure that scheme is reimbursed amounts claimed from third party
- Check all payments against benefits utilised and ensure that they correspond, close file and delete filter, if not obtain settlement agreement or query settlement with RAF
- Administration responsibilities
- Propose system enhancements that will ensure better workflow
- Monitoring and enforcing changes with regards to RAF legislation

**Engage with clients in a client centric manner (Client Services)**
- Investigate client queries within the agreed service level and ensure that client receives timeous feedback
- Escalate client queries to the relevant department or stakeholder
- Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate after sales services
- 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

**Self-management and teamwork**(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 and performance excellence

**Contribute to financial controls and planning (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**
- Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
- Anticipates, meets and exceeds client’s needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity
- Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
- Actively leads change, does what is right for the business and drives continuous improvement through innovation.
- Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others and encouraging them to contribute to the best of their ability.
- Prioritises t

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