Claims Consultant at Momentum Metropolitan Holdings Limited

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’ experience in processing claims
• Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (desirable)
• Exposure to the insurance or financial services industry (desirable)
• Formal qualification: Grade 12 or equivalent qualification
• Formal qualifications: Diploma / Degree or Industry-related qualification (Short-term, long-term, retail, wealth management)
• Knowledge of specific life insurance products, systems, processes and procedures (advantageous)
• MS Office Suite (Word, Excel)
• Proficient in English (Afrikaans advantageous)

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 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 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.
• Fincance 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.
• Interpreting Data: Interprets data rationally by quantifying issues applies technology as a means to evaluating data evaluates information objectively.
• Interacting with People: Is lively and projects enthusiasm is talkative in making contact is focused on interacting and networking with people.
• Making Decisions: Is determined and decides on actions willingly assumes responsibility is definitive and stands by own decisions.
• Meeting Timescales: Is target focused and meets deadlines is punctual and keeps to schedule is reliable in finishing tasks.
• Managing Tasks: Manages tasks by being organised and methodical plans activities systematically sets priorities for tasks.
• Producing Output: Is focused on activity and works quickly keeps busy and maintains productivity is comfortable multitasking to produce output.
• 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.
• Interpreting Data: Interprets data rationally by quantifying issues applies technology as a means to evaluating data evaluates information objectively.
• Interacting with People: Is lively and projects enthusiasm is talkative in making contact is focused on interacting and networking with people.
• Making Decisions: Is determined and decides on actions willingly assumes responsibility is definitive and stands by own decisions.
• Meeting Timescales: Is target focused and meets deadlines is punctual and keeps to schedule is reliable in finishing tasks.
• Managing Tasks: Manages tasks by being organised and methodical plans activities systematically sets priorities for tasks.
• Producing Output: Is focused on activity and works quickly keeps busy and maintains productivity is comfortable multitasking to produce output.

Closing Date    

• 2026/03/20