Senior Claims Assessor

2 days ago

Cape Town, South Africa Momentum Metropolitan Holdings Full time

-Introduction

Metropolitan is one of the oldest financial services brands in South Africa. With a 116-year legacy of serving the communities in which it operates, Metropolitan represents true empowerment in serving Africa's people through affordable financial solutions that create financial growth and security.
Role Purpose

The purpose of this role is to audit and authorise payments and to ensure adherence to the claim’s philosophy as well provide training and mentorship to claims consultants and handling complex claims across the Risk and Saving Product portfolio.
Requirements
- Grade 12 with Maths / Accountancy/ NQF4 equivalent
- Metropolitan product knowledge in terms of policy benefits, exclusions, and legislative requirements advantageous
- 3 years Claims, Unclaimed Benefits and Service experience
- Working knowledge and understating of Retirement Annuity Claims, Death, Disability, Hospitalization and Critical Illness claims, Maturity and Early Retirement claims as well as Early Terminations
- An understanding of the Section 14 Transfer process
- Metropolitan product knowledge in terms of policy benefits, exclusions and legislative requirements
- Working knowledge and experience of all operating in-house systems
- Understanding of long term insurance
- Knowledge and understanding of Insurance Legislation, Pension Fund Act and TCF
Duties & Responsibilities
- Audit claims in line with the insurance policy definitions and exclusions.
- Assess all claims information and forward all incomplete documentation to the relevant stakeholder for resolution.
- Resolve escalated claim queries and ensure queries are processed in a timeously manner.
- First line of escalation and decision making in respect of complex claims
- Monitor and manage the adherence to the claim’s framework as well as service level agreements
- Coach and guide claim team in claims management processes and procedures.
- Ensure that the necessary risk management controls are in place
- Assess, quality control and authorise the payment of claims within limit
- Answer all claims related queries telephonically and in writing
- Train incumbents in claims processes and procedures
- Assist with identified projects
- Liaise with various external and internal role players
- Manage day-to-day work queues by adhering to the following:

- Ensure the understanding of daily assigned tasks
- Ensure the understanding of the methodologies and procedures to complete the assigned tasks and achieving set targets
- Ensure the understanding of tracking of own results and giving and receiving feedback on problems experienced during the completion of the tasks
- Ensure the understanding of feedback on performance and accepting the help of other
- Ensure that problems are identified and solved as soon as possible
- Keep track of own performance to adhere to the standardized quality objectives
- Request tax directives from SARS where applicable
- Attention to detail and quality of work should be thorough.
- Assist with Ombudsman / Client Care queries.
- Make recommendations to improve client service and fair treatment of clients within area of responsibility
- Develop and maintain productive and collaborative working relationships with peers and stakeholders
- Positively influence and participate in change initiatives
- Provide authoritative, expertise and advice to clients and stakeholders
- Build and maintain relationships with clients and internal and external stakeholders
- 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
- Business Acumen
- Client/ Stakeholder Commitment
- Drive for Results
- Leads Change and Innovation
- Motivating and Inspiring Team
- Collaboration
- Impact and Influence
- Self-Awareness and Insight
- Diversity and Inclusiveness
- Growing Talent
- Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

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