Key Purpose of the role
The primary function of this role is to effectively manage Disability Claim administration and provide integrated services to internal and external clients within the Group Risk Claims Department. In addition to this, the individual will be responsible for the technical assessment of claims by checking the applicable cover, scheme and member details, eligibility, financial details.
Areas of responsibility may include but not limited to
Ensure the effective validation and assessment of all disability claims according to company policy whilst having a client centered approach ingrained into the communication and management of all relevant stakeholders and clients
Review and follow up on all types of disability claims within agreed authority structures and targets in accordance to client service levels, claims management and process requirements
Makes correct decisions - medically researched, legally defendable, fair, equitable and justifiable final decisions
Communicate to internal and external stakeholders on set requirements, decision letters and progress on claims in a clear, friendly and concise manner using appropriate language and a client centric approach
Ensure all Internal and External communication (Written and Verbal) is done so in a professional manner and in line with the company policy and does not contravene the POPI Act.
Ensure that all queries are answered correctly in a logical and fair manner in accordance client service levels using a client centric approach
Bring medical expertise, experience and skills and assist with continual medical training, coaching, mentoring, development, empowerment and performance of fellow disability claims team members.
To liaise with associated persons such as Medical Officers, Reinsurers, Legal Officers, rehabilitation consultants, investigators and management
Work effectively in a team environment, share information and provide support to other team members
Contribute to team and cross-team processes, discussions, interactions, activities and programmes
Create and Implement initiatives and opportunities for change and improvement - within the team, business and self.
Maintains and develops professional relationships with internal and external clients and ensure the best communication with customers using a client centric approach.
Seeks and receives the advice and input of others
Seeks involvement in projects of varying subject matter.
Participate in personal and professional development activities, training and courses
Additional ad hoc preparations for Audits (Internal and External), Compliance audits
Personal Attributes and Skills
Resilience
Working with People
Results Driven
Decision making skills
Organizational awareness
Attention to detail
Analytical
Adaptable/ flexible
Creative and innovative
People orientated
Team player
Customer centric
Dependability and Reliability
Self-starter
Quality Oriented
Teamwork/Collaborative
Integrity
Tenacity
Education and Experience
Relevant tertiary qualification
Decision making skills
Time management skills
Verbal and written communication skills
Problem solving skills
Claims payments processing product and process knowledge of Employee and Disability products
Advanced MS Office Excel skills (Essential)
Organizational skills
Knowledge and understanding of Employee Benefits and Claims Payments administration
2-3 years relevant experience such as working in the risk/health insurance industry