Motor Merit Moderator at Old Mutual South Africa

Job Description

Old Mutual Insure is looking for forward thinking , creative and Innovative Motor Merit Moderators

The role is responsible for Merit Moderation process, drive the delivery of sound practices to achieve the desired business outcome. The purpose of the Merit Moderator is to collaborate, scrutinize and guide the Claims Staff in the claims assessment process to enable the optimal claims settlement in paying for valid claims in terms of the policy conditions, merit, and quantum of the claims

You will be Responsible for :-

Critical objectives and responsibilities

Collaborate, implement, and ensure the delivery of Merit Moderation to achieve a high quality of claims assessment and settlement.

• Review claim, request and analyse policy files and relevant related documents, if not already provided
• Review assessors’ findings and confirm acceptance as appropriate.
• Manage own claims processing functions and ensure accurate and timely processing of claims within established legal and company compliance.
• Execute the operational strategy for merit moderation.
• Collaborate effectively with key role players across the insurance value chain i.e., Technical Underwriting, Claims Assessing, Claims Handling staff and Distribution staff.
• Ensure management information is produced accurately and timeously for various management packs to provide the required data insights and aid decision-making regarding priorities and business plans.
• Implement action plans to contribute towards the organizational strategy and link setting of standards, targets, and overall objectives towards the achievement of the organizational strategy.
• Produce weekly/monthly KPI’s, dashboards and analytics to measure and improve performance.
• Manage Workload and escalate capacity gaps.

Continuous improvement to ensure effective service.

• Ensure statutory and legislative knowledge is always current to resolve customer complaints, to advise the business on corrective solutions to mitigate risks and to improve the customer experience whilst complying with governance requirements.
• Implement improvements in the merit processes to drive efficiency and effectiveness.
• Collaborate with claims staff to ensure outputs of the merit moderation function is aligned with business expectations and objectives.
• Reduce turn-around through improved methodologies.
• Ensure adherence to organisational policies, practices, guides, mandates, and procedures.
• Identify solutions to enhance cost effectiveness and increase operational efficiency.

Service delivery to ensure customer satisfaction.

• Maintain service, quality, and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures, and standards.
• Establish productive operational relationships with key stakeholders in the various channels and administrative teams.
• Develop work routines in line with operational plans / schedules to manage achievement of service delivery goals.
• Proactively identify and implement changes required in customer service and relations.
• Develop customer solutions to address changing service requirements, implement customer-centric approaches to deliver customer satisfaction.
• Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.

Cost control and governance adherence

• Proactively ensure use of time, of resources, money, materials, or equipment is in line with policies and procedures.
• Comply with corporate governance policies, procedures, and standards.
• Operate within agreed mandates.

Quality people practices

• Align own behaviour with the organisation culture and values.
• Share and transfer product, process, and systems knowledge to colleagues.
• Ensure achievement of own performance objectives.
• Actively share information with other team members regarding successes, issues, trends, and ideas.
• Actively participate in own professional development and career path.
• Actively promote a culture of learning and high-performance culture amongst team members.

Experience, knowledge & skills required

• A bachelor’s degree or advanced diploma at NQF level 7 in a relevant field or equivalent.  Examples of relevant studies which will be advantages.
• Certified Fraud Examiner
• Short Term Insurance related qualifications
• Minimum of 5-8 years’ experience in the handling of Motor related claims
• Key understanding of Underwriting practices in both Personal Lines and Commercial Underwriting
• Motor Assessing Experience