Claims Assessor

1 day ago


Centurion, Gauteng, South Africa MMI Holdings Ltd Full time
About Metropolitan

Metropolitan is a renowned financial services brand in South Africa, boasting a 116-year legacy of serving local communities through affordable and innovative solutions. As part of MMI Holdings Ltd, we empower individuals and families to achieve financial growth and security.

Our presence extends across South Africa and seven African countries, providing comprehensive financial wellness solutions that cater to the needs of low-income clients. These include funeral insurance, health, savings, hospital cash-back cover, retirement solutions, and life insurance.

Job Purpose

This role is centered around assessing, reviewing, and managing living benefit claims according to relevant legislation and company policies. The successful candidate will be expected to adhere to service level agreements while meeting client and business expectations.

Key Responsibilities
  • Assess and review disability, dread disease, and income disability claims, ensuring they meet service level agreements.
  • Partner with stakeholders to improve claims assessment and enhance the client's experience.
  • Contribute to the development of procedures and processes within the area of specialization for continued quality and service improvement.
  • Maintain accurate records of all claims assessed in accordance with business expectations and relevant legislation.
  • Stay updated on regulatory frameworks, insurance-related court decisions, and determinations by regulatory bodies that could impact claim processing or handling.
  • Support continuous improvement efforts through identifying opportunities for cost reduction, quality enhancement, and systems improvement.
  • Provide expertise and testing support for claims system development and maintenance to ensure efficiency and quality.
  • Review and provide input into claims policies, practices, forms, and documentation to align with risk management standards and product changes.
  • Deliver accurate and timely reporting, analysis, and insights on claims assessed as required.
  • Offer authoritative expertise to clients and stakeholders.
Requirements
  • Grade 12 or equivalent qualification.
  • Minimum 1-2 years of experience in claim processing.
  • Relevant insurance or medical aid claims assessment experience (paper and/or EDI).
  • Strong analytical skills.
  • Attention to detail.
  • Excellent interpersonal skills.
  • Problem-solving skills.
  • Knowledge of relevant legislation and industry regulations.
  • Familiarity with claims assessment processes (paper and EDI).
  • Awareness of relevant scheme or product rules.
  • Understanding of claims operating systems and tools.
Competencies
  • Examining Information.
  • Documenting Facts.
  • Interpreting Data.
  • Interacting with People.
  • Making Decisions.
  • Meeting Timescales.
  • Managing Tasks.
  • Effective Communication Skills.
  • Service Orientation.
  • Prioritization Skills.
Salary and Benefits

The estimated annual salary for this position is R600,000 – R800,000, depending on experience and qualifications. In addition to a competitive salary, we offer a range of benefits, including comprehensive medical aid, retirement savings plan, and paid time off.


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