Claims Assessor

2 weeks ago


Centurion, South Africa Momentum Metropolitan Holdings Full time

-Introduction

The Retail Life Insurance department is looking for a self-driven, dynamic healthprofessional who wants to grow their career in Claims Assessment. Myriad is Momentum'smarket-leading life insurance product, providing life cover to clients in South Africa. OurMyriad product aim in partnering with our clients on their journey to success. We strive tofind opportunities in every risk and ensure that current and potential clients can benefitfrom our innovative solutions. Part of the reason why Myriad has the unique ability todevelop superior, forward-thinking products and benefits is because we make it ourbusiness to understand our clients' varying needs.
Role Purpose

To be part of a team that provides market leading claims assessment capability for livingbenefits (critical illness, income and disability benefits). This will include specialising in income disability, lump sum disability, critical illness and case management for livingbenefits, the completion of quality industry assessments within the required service levels.
Requirements

**Experience and Qualification**
- B./BSc. Occupational Therapy, Physiotherapy or Psychology or Qualified Registered Nurseor other health sciences related degree considered appropriate
- 1-3 Experience in life insurance claims
- Relevant insurance knowledge, applicable regulatory requirements and legislationsbeneficial
- Experience of general retail protection market product offerings beneficial
Duties & Responsibilities
- Execution of the claims assessment methodology across Critical Illness, Income Protectionand Lump Sum Disability benefit lines.
- Approves or declines claim submissions without supervision within company guidelines.
- Support team members with best practice techniques, medical practice through knowledgesharing.
- Selects and accepts major risks on behalf of the company, evaluating proposals rather thanmechanistic assessment.
- Assist with the overall improvement of risk management within the living benefitsassessment area.
- Current best industry and company practices
- Claims research
- Technological enablers
- To partner and collaborate with both internal and external stakeholders, not limited toproduct development, underwriting, CMO, reinsurance partners to improve claimsassessment and client experience.
- Ensure that assessment methodology and execution is in line with legislation and bestpractices within the financial management field in order to optimise the claims assessmentservice offering and deliver.
- Familiar with the regulatory framework, insurance related court decisions and/ordeterminations by regulatory bodies, governing bodies etc. that could impact the wayclaims are processed or handled.
- Risk opportunity identification to prevent fraud and to deliver quality work.
Build and maintain relationships with internal stakeholders responsible for the primary client
- Build and maintain relationships with internal stakeholders responsible for the primaryclient and advisor interactions (claims consultants).
- Follow internal client service practices which build rewarding relationships and enablesexceptional client service
- Contribute to a client service excellence culture which builds enduring relationships andallows team to provide exceptional client service.
- Incorporate internal assessment feedback into the enhancement of daily business processesand management operating systems.
- Act in a way that allows for a positive work climate and culture with fellow employees.
Competencies
- Business acumen
- Client / Stakeholder commitment
- Assertiveness
- Drive for results
- Diversity and inclusiveness
- Collaboration and team work
- Impact and influence
- Results and solution focused
- Self-awareness and insight
- Diversity and inclusiveness

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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