Ex-gratia Administrator

**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.

**Role Purpose**

To prepare cases to be reviewed by the Client's Ex-Gratia Committee Board members.

**Requirements**:
**Qualifications**:

- Grade 12 or equivalent
- Relevant Degree or Diploma in a clinical field (Advantageous)

**Knowledge & Experience**:

- 2 - 3 years medical aid experience
- 2 - 3 years client service experience
- Extensive computer experience on Ms Word and Outlook
- Basic knowledge of claims and reading filters

**Duties & Responsibilities**

**Internal Process**:

- Perform administrative duties and provide a professional service to GEMS members, where special grants
are requested in cases where medical expenditure, in excess of the Scheme's limits, has caused and or would
cause financial hardship for members.
- Establish and maintain knowledge of Ex Gratia Guidelines and mandates, Scheme Rules, Benefit Exclusions
and Claims operational systems.
- Process all documentation received from members, service providers, Managed Care Service providers and
the Scheme or Principal Officer accurately and timeously and confidentially.
- Accurately investigate and prepare Ex Gratia cases for presentation by the Ex Gratia Manager to the Ex
Gratia Committee, comprising of the Scheme's Board of Trustees and the Scheme officials.
- Provide and maintain accurate and thorough telephonic information to members, service provider and
Business Partners regarding queries for claims and general client services relating to Ex Gratia.
- Finalise and communicate meeting outcomes for members and draft outcome letters.

**Client**:

- Build and maintain relationships with clients and internal and external stakeholders.
- Deliver on service level agreements applicable to 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.
- Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
- Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.
- Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.

**People**:

- Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
- Positively influence and manage change and offer specialist support where required.
- Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
- Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.
- Take ownership for driving career development.

**Finance**:

- Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.
- Identify solutions to enhance cost effectiveness and increase operational efficiency.
- Implement and provide input into governance processes, systems and legislation within area of specialisation.
- Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.
- Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.

**Competencies**
- Business Accumen
- Building Strong Relationship
- Sense of urgency, focus, accountability, agility and execution
- Change Management
- Persuades, convinces, influences and inspires others
- Manages self and relationships with others
- Inclusivity and Humility