Team Leader: Claims

**Introduction**
- Momentum Health, an entity of Momentum Group delivers sustainable,integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation,and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**
- To manage and maintain claims processing service levels in the Claims Team to exceed client expectations.

**Requirements**:

- Matric or equivalent - (essential)
- Knowledge of the medical scheme administation business essential
- 3 - 4 years’ experience in a Medical Scheme Administration Claims environment - (essential)
- 1 - 2 years’ People management experience - (essential)
- Relevant tertiary qualification would be preferred.

**Knowledge**
- Sound knowledge of Medical Scheme claims policies, procedures and processes
- Computer Literacy - MS Office: Work, Excel, Outlook and other business-specific software
- Knowledge of performance metrics

**Duties & Responsibilities**
- INTERNAL PROCESS
- Manage, monitor and control the Claims team’s delivery on Service Level Agreements made with clients.
- Manage, monitor and control the team’s execution of client claims and queries.
- Act as an escalation point to assist Claims team addressing client queries.
- Ensure team’s adherence to correct procedure when following up on queries.
- Analyse the Claims Administration processes and identify opportunities for improvements; implement improvements within the Claims team.
- Identify and report process and system failures and enhancements to improve client experience.
- Investigate client queries within the agreed service level and ensure that client receives timeous feedback.
- Escalate client queries to the relevant department or stakeholder.

CLIENT
- Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate after sales services.
- Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets.
- Provide authoritative, expertise and advice to clients and stakeholders.
- Build and maintain relationships with clients and internal and external stakeholders.
- Deliver on service level agreements made with 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.

PEOPLE
- Develop and maintain productive and collaborative working relationships with peers and stakeholders.
- Positively influence and participate in change initiatives.
- Continuously develop own expertise in terms of professional, industry and legislation knowledge.
- Contribute to continuous innovation through the development, sharing and implementation of new ideas.
- Take ownership for driving career development.

FINANCE
- Contribute to the financial planning process within area.
- Identify opportunities to enhance cost effectiveness and increase operational efficiency.
- 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**
- Adopting Practical Approaches
- Making Decisions
- Upholding Standards
- Generating Ideas
- Directing People
- Producing Output
- Developing Strategies
- Empowering Individuals
- Time management