Technical Claim Specialist at Momentum Metropolitan Holdings Limited

Technical Claim Specialist

To apply best-practice methodologies in the designing, training and monitoring of the effectiveness of living benefit assessing within the claims team and ensure optimal technical skill development of the claims assessors.

Responsibilities and work outputs

• Assist with development and execution of an industry renowned claims assessment methodology across Critical Illness, Income Protection and Lump Sum Disability benefits through continuous development interventions for assessors based on current best industry and company practices and technological enablers.
• Ensure that assessment methodology and execution is in line with legislation and best practices within the financial management field in order to optimise the claims assessment skill development of assessors.
• Understand the regulatory framework, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Collaborate with business stakeholders to determine the product and technical assessing approach and implement the execution of training interventions.
• Partner and collaborate with both internal and external stakeholders, not limited to product development, underwriting, CMO, reinsurance partners to improve claims’ training assessment interventions.
• Manage the quality of training interventions for groups and individual to ensure the correct skills, knowledge and behaviour is embedded.
• Analyse technical assessment quality and make recommendations for improvement of assessor’s skills.
• Assist with the quality audit of claims assessment and align assessing training and development in order to improve assessor’s skills.
• Recommend training opportunities (formal and informal) aligned to assessor skills gaps, in order to enhance processes and increase effectiveness
• Manage and implement training activities with the specific aim to increase and improve assessing skill and efficiencies.
• Coach and guide assessors to improve their assessment skill and interpretation of claims assessment.
• Sign off assessments within the delegated authority level and required service levels aligned to product and policy requirements.
• Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
• Providing insight, knowledge, assistance and provide testing support where necessary as part of the development and maintenance of all claims systems to improve quality and efficiency.
• Assist with the review of all claims policies, practices, forms and documentation to ensure that our risk management standards are met and aligned to relevant product changes and legislative updates.
•  Assist with the delivery of accurate and timeous reporting, analysis and insights where required, and implementation of findings into the execution of claims assessment to improve the client experience and risk management.
• Build and maintain relationships with clients, internal and external stakeholders
• Deliver on service level agreements with all stakeholders to ensure that client expectations are met and managed
• Make recommendations to improve client experience 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
• Ensure compliance to regulatory Treating Customer Fairly outcomes
• Develop and maintain productive and collaborative working relationships with peers, team members 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
• Responsible to manage, identify and mitigate risk through the adherence of the claims process
• Identify 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.

Qualifications and experience

• Matric
• Degree in Health Sciences (Occupational Therapy, Physiotherapy,Psychology)
• 5+ years experience in life insurance claims would be beneficial
• Relevant insurance knowledge, applicable regulatory requirements and legislations would be beneficial