Overview
Claims Assessor Jobs in Centurion, South Africa at Health Solutions
Introduction
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture ofinnovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
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
Grade 12 or equivalent qualification
1-2 years experience in processing claims
Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (desirable)
Relevant degree or qualification
Knowledge of relevant legislation and industry regulations
Knowledge of the claims assessment process (paper and EDI)
Knowledge of the relevant scheme or product rules
Knowledge of relevant claims operating systems and tools
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 client’s 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 withcontinuous improvementefforts 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 andfair treatmentof 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 andcollaborativeworking 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 continuousinnovationthrough the development, sharing and implementation of new ideas.
Take ownership for driving…
Title: Claims Assessor
Company: Health Solutions
Location: Centurion, South Africa
Category: Insurance, Healthcare
