Claims Assessor at Momentum Metropolitan Holdings Limited

Introduction

The Retail Life Insurance department is looking for a self-driven, dynamic health professional who wants to grow their career in Claims Assessment. Myriad is Momentum's market-leading life insurance product, providing life cover to clients in South Africa. Our Myriad product aim in partnering with our clients on their journey to success. We strive to find opportunities in every risk and ensure that current and potential clients can benefit from our innovative solutions. Part of the reason why Myriad has the unique ability to develop superior, forward-thinking products and benefits is because we make it our business to understand our clients' varying needs.

Role Purpose

To be part of a team that provides market leading claims assessment capability for living benefits (critical illness, income and disability benefits). This will include specialising in income disability, lump sum disability, critical illness and case management for living benefits, the completion of quality industry assessments within the required service levels.

Responsibilities and work outputs

• Contribute to the ongoing enhancement and execution of the claims assessment methodology across Critical Illness, Income Protection and Lump Sum Disability benefit lines.
• Approves or declines claim submissions without supervision within company guidelines.
• Selects and accepts major risks on behalf of the company, evaluating proposals rather than mechanistic assessment.
• Under general direction, assess complex cases that involve greatest risk.
• Provide guidance and assistance to claims assessors and consultants.
• Guide team members with risk assessment techniques, medical knowledge and best practice guidelines
•  Assist with the overall improvement of risk management within the living benefits assessment area.
• Continuous development and application to ensure successful execution of the claims assessment methodology, including:

1. Current best industry and company practices,
2. Claims research and
3. Technological enablers.

•  Embedding and applying established practices to ensure consistent application of these in the claims assessment environment.
• To partner and collaborate with both internal and external stakeholders, not limited to product development, underwriting, CMO, reinsurance partners to improve claims assessment and client experience.
•  Ensure that assessment methodology and execution is in line with legislation and best practices within the financial management field in order to optimise the claims assessment service offering and deliver.
•  Familiar with the regulatory framework, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Risk opportunity identification to prevent fraud and to deliver quality work.
• Assist with continuous improvement efforts by the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
•  Embed and apply tools that allow for more efficient decision making, processing and risk management capabilities.
•  Providing insight, knowledge, assistance and provide testing support where necessary as part of the development and maintenance of all claims systems to improve quality and efficiency.
• Assist with the review of all claims policies, practices, forms and documentation to ensure that our risk management standards are met and drafting new policies and practices where necessary.
•  Ensure delivery of timeous and consistent claims assessments to Claim Consultants by managing and maintaining workflow and service level standards.
•  Assist with the delivery of accurate and timeous reporting, analysis and insights where required, and implementation of findings into the execution of claims assessment to improve the client experience and risk management.
• Build and maintain relationships with internal stakeholders responsible for the primary client and advisor interactions (claims consultants).
• Follow internal client service practices which build rewarding relationships and enables exceptional client service.
• Contribute to a client service excellence culture which builds enduring relationships and allows team to provide exceptional client service.
•  Incorporate internal assessment feedback into the enhancement of daily business processes and management operating systems.
• Act in a way that allows for a positive work climate and culture with fellow employees

Competencies required

• Business acumen
• Client / Stakeholder commitment
• Assertiveness
• Drive for results
• Collaboration and team work
• Impact and influence
• Results and solution focused
• Self-awareness and insight
• Diversity and inclusiveness

Experience and Qualifications

• B./BSc. Occupational Therapy, Physiotherapy or Psychology Or Qualified Registered Nurse or other health sciences related degree considered appropriate
• 3-5 Experience in life insurance claims with experience managing complex claims Relevant insurance knowledge, applicable regulatory requirements and legislations beneficial
• Experience of general retail protection market product offerings

Additional information

• Seniority is determined on years of experience and areas of experience.