Disability Claims Assessor at Momentum Metropolitan Holdings Limited

Role Purpose    

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

Requirements    

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

Duties & Responsibilities    

• Ensure Service Level Agreements are met and exceeded.
• 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 organisational best practice and legislative requirements.
• Ensure effective claims management service delivery and support.
• Perform an efficient and accurate administrative function.
• Identify and investigate all possible non-disclosure of 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.
• 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.
• Keep Knowledge of current legislation relevant to the industry

Competencies    

BUSINESS ACUMEN

• Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group.

CLIENT COMMITMENT

• Anticipates, meets and exceeds client’s needs by creating long lasting relationships that support the client value proposition, supports their financia wellness and ensures client centricity.

DRIVE FOR RESULTS

• Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.

LEADS CHANGE AND INNOVATION

• Actively leads change, does what is right for the business and drives continuous improvement through innovation.

COLLABORATION

• Prioritises the business interests of MMI and invests in the success of the group by aligning effort across divisions.

IMPACT AND INFLUENCE

• Persuades, convinces, influences and inspires others, both within MMI and externally to win support, loyalty and gain commitment to the purpose of MMI.

SELF-AWARENESS AND INSIGHT

• Manages self and relationships with others effectively and provides perspective in difficult situations.

DIVERSITY AND INCLUSIVENESS

• Is sensitive to individual and cultural similarities and differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.

Closing Date    

• 2026/03/03