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Claims Assessor

2 weeks ago

Centurion, South Africa Momentum Metropolitan Holdings Full time

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.

Metropolitan operates in South Africa, but the brand is also present in 12 African countries including, Namibia, Botswana, Kenya, Ghana, Nigeria, Lesotho, and Swaziland.
Metropolitan provides financial wellness solutions that meet the needs of low income clients, including funeral insurance, health, savings, hospital cash-back cover, retirement solutions and life insurance.

Role Purpose
Assess, review and manage living benefit claims, in accordance with relevant legislation and company policy, adhering to service level agreements and meeting client and business expectations.

**Requirements**:

- 1-2 years’ work experience in processing claims
- Experience in the assessment of relevant insurance or medical aid claims, paper and/or EDI
- Grade 12 or equivalent qualification
- Relevant degree or qualification

Duties & Responsibilities

INTERNAL PROCESS
- Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level agreements.
- Partner and collaborate with relevant stakeholders, to improve claims assessment and the clients claim experience.
- Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
- Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation.
- Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
- Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
- Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
- Give input into and review claims policies, practices, forms and documentation to ensure that risk management standards are met and aligned to relevant product changes and legislative updates.
- Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required.

CLIENT
- Provide authoritative expertise 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 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 stakeholder.
- 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
- Examining Information
- Analyses and processes information
- Asks probing questions
- Strives to find solutions to problems
- Documenting Facts
- Writes fluently when documenting facts
- Understands arguments logically; focuses on finding facts
- Interprets data rationally by quantifying issues; applies technology to evaluating data; evaluates information objectively., Interacting with People
- Making Decisions; determined and decides on actions; willingly assumes responsibility; definitive and stands by own decisions.,
- Meeting Timescales: target focused and meets deadlines, punctual and keeps scheduling and reliable in finishing tasks
- Managing Tasks; Manages tasks by being organised and methodical plans activities systematically, sets priorities for tasks
- Producing Output; focused on activity and works quickly, keeps busy and maintains productivity, comfortable multitasking to produce output.

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointm