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 applies clinical expertise.

Requirements    

Experience And Qualifications

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

Additional Requirements:

• Role requires travelling to clients; code B license and own vehicle required.
• Understanding of medical conditions and their implications for functional ability, especially as they relate 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 the company's values are demonstrated 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, ensure they are correctly completed and indexed, and no duplication and that 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, expert 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.
• Manage 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.

Closing Date    

• 2026/07/15