Disability Claims Assessor: Momentum

Disability Claims Assessor. Momentum is recruiting for a Disability Claims Assessor based in Cape Town.

Reference Number: MMH240710-3

Role Purpose

Receives disability claims and assesses payment of benefits in accordance with the rules of the fund and in applying clinical expertise.

BOT (Bachelor of Arts Occupational Therapy) / BSc.OT degree or BSc Physiotherapy.
Registration with the HPCSA as OT, or Physio
Minimum 1-year relevant experience.

Additional Requirements:

Role requires travelling to clients, code B license and own vehicle required.
Understanding of medical conditions and their implication on functional ability, especially relating to job requirements.
Understanding and knowledge of the group insurance Industry.
Appreciation of future trends within Employee Benefits.
Knowledge of current legislation relevant to the industry.

Internal Process

Develop effective relationships with stakeholders at all levels of the organization, including 3rd parties and service providers.
Monitor customer delivery constraints and escalate exceptions to management.
Ensure Service Level Agreements are met.
Identify risks to the company and escalate accordingly.
Monitor claims received to ensure that duplication does not occur resulting in financial loss to the company.
Drive and support effective teamwork within the department.
Engage in appropriate training interventions to promote own professional development.
Ensure to demonstrate the company’s values on a daily basis.
Adhere to organizational best practice and legislative requirements.
Ensure effective claims management service delivery and support.
Perform an efficient and accurate administrative function.
Identify and investigate all pre-existing conditions.
Validate all claims, and ensure they are correctly completed and indexed, and no duplication and whether pre-approval has been obtained.
Adhere to policies and procedures and take corrective action where necessary.
Ensure all risks are mitigated and escalated where necessary.

Client

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.
Managing the client relationship, attend client meetings and facilitate training in respect of claims processes
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

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