Disability Claims Assessor (centurion) X4

Location: centurion, pretoria, South Africa
Date Posted: 09-03-2018
Our Clients purpose is to enhance the lifetime Financial Wellness of people, their communities, and their businesses. Financial Wellness is a continuous process of planning and management for individuals, households, and businesses, with the aim of affording expenses and achieving goals over one’s lifetime. Our promise to our clients is to be their Financial Wellness partner over this life-long journey, using our expertise and solutions to help them develop and reach their goals.

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.

• Develop effective relationships with stakeholders at all levels of the organisation, including 3rd parties and service providers.
• Monitor customer delivery constraints and escalate exceptions to management.
• 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.

What you'll need:
• 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 in Employee Benefits.
• Knowledge of current legislation relevant to the industry.

Competencies required
• Action and results orientation
 • Innovation •
Leveraging Technology
• Numeracy
 • Reading and Comprehension
 • Relationship Building
 • Working in teams

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

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