Disability Claims Assessor MMH

Role Purpose

Receives disability claims and assesses payment of benefits in accordance with the rules of the fund and in applying clinical expertise.

• BOT (Bachelor of Arts Occupational Therapy) / BSc.OT degree or BSc Physiotherapy.
• Registration with the HPCSA as Occupational Therapist or Physiotherapist.
• Minimum 1 year relevant experience.
• Driver's license and willing to travel.

• Ensure Service Level Agreements are met and exceeded.
• Identify risks to the company and elevate 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.
• 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 within Employee Benefits.
• Keep knowledge of current legislation relevant to the industry.