Clinical Underwriter

-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
- This role offers exciting and challenging opportunities and is aimed at a dynamic, performance-orientated, knowledgeable, and experienced individual, who is able to deliver quality outputs in a high deadline and client-orientated environment.
- You will be required to investigate non-disclosure cases and provide a decision in line with the underwriting guideline as set out in the GEMS scheme rules and Medical Scheme Act (legislation) as set out by CMS.
- Analyze, update and effect changes to the underwriting and non-disclosure exceptions. Assess underwriting non-disclosure escalations accuracy and update accordingly.
- Process the loading of the condition-specific waiting period in line with underwriting guidelines as set out in the GEMS scheme rules and Medical Scheme Act (legislation) as set out by CMS.
Requirements
- Matric or Grade 12 qualification.
- Clinical degree qualification or equivalent.
- 2 - 3 year's Clinical Health Risk Management experience.
- Claims assessing experience or knowledge.
- Clinical preauthorization experience.
- Health underwriting and non-disclosure experience.
- Medical aid industry experience and exposure would be an advantage.
Duties & Responsibilities
- Provide underwriting, non-disclosure and claims advise and support related to moderate and complex assessment that involves risk for the organization.
- Investigate client queries within the agreed service level and ensure that client receives timeous feedback.
- Review claims and authorizations history to potentially identify additional non-disclosed health conditions.
- Develop and maintain productive and collaborative working relationships with peers and stakeholders.
- Create and maintain underwriting policy and guidelines to ensure consistency and make sure decisions are defendable.
- Manage non-disclosure escalations within the stipulated turnaround time.
- Ability to build positive relationships and partnerships with clients and key stakeholders.
- Plan for administering, and processing beneficiaries' health information effectively and efficiently in line with performance objectives.
- Conduct underwriting and medical research in collaboration with stakeholders in areas that require investigation.

Dealing with client in a competent and professional manner according to quality standards
Competencies
- Strong knowledge and understanding of the Underwriting and Non-disclosure process.
- Medical industry knowledge.
- Customer orientation.
- Teamwork and Cooperation skills.
- Strong communication skills.
- Ability to provide technical knowledge and advice to both internal and external customers to assist in decision-making.
- Research and information gathering skills.
- Reporting and interpretation gathering skills

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.