Disability Claims Assessor at Momentum Metropolitan Holdings Limited

Role Purpose    

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

Requirements    

• Bachelor of Occupational Therapy / Bachelor of Physiotherapy
• Registration with the HPCSA as OT, or Physio
• Successfully completed mandatory Community Service year.

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

Duties & Responsibilities    
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

Competencies    

• Business Acumen
• Client Commitment
• Drive for Results
• Leads Change and Innovation
• Impact and Influence
• Collaboration and teamwork
• Self-Awareness and Insight
• Diversity and Inclusiveness
• Excellent clinical reasoning
• Proficient in Microsoft Applications e.g. Outlook, Word, Teams, PowerPoint, OneDrive, Power BI etc.

Deadline:28th July,2025