Claims Assessor (Admed) at Momentum Metropolitan Holdings Limited

Role Purpose    

• To process medical expense shortfall (Gap cover) claims in accordance with stipulated service levels and policy conditions.

Requirements    

• Matric
• Computer literacy
• FAIS FIT and proper, including RE5
• At least 2 years of experience in short-term or medical health and accident insurance handling.
• At least 2 years of client service experience.
• Good knowledge of the local health industry, including the application of ICD-10 and BHF tariff codes
• Knowledge of the OWLS system is advantageous.

Duties & Responsibilities    

• Coordinate gap cover claims received from contracted medical schemes to ensure a seamless claims experience for mutual customers.
• Address client and broker queries within the stipulated time frame.
• Ensure all registered claims are assessed and administered effectively and efficiently in accordance with relevant legislation and policy wording.
• Communicate with relevant medical schemes via email or telephone regarding outstanding documentation.
• Accurately and completely capture clinical details in the OWLS claims administration system.
• Monitor system communications related to claims to keep customers and brokers updated on the claims process.

Competencies    

• Results and solution-driven
• Strong focus on client centricity and service excellence
• Strong problem-solving and decision-making capabilities
• Analytical with attention to detail
• Resilience and ability to work under pressure
• Effective communication skills and professional client management

Closing Date    

• 2026/06/17