Disability Claims Assessor MMH

Role Purpose

Receives disability claims and assesses payment of benefits in accordance to 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 OT, Physio or Nurse.
• Nursing Qualification
• Minimum 1 year relevant experience.

• Ensure Service Level Agreements are met and exceeded.
• Identify risks to the company and elevate accordingly.
• Monitor claims received to ensure duplication does not occur, preventing financial loss to the company.
• Drive and support effective teamwork within the department.
• Engage in appropriate training interventions to promote own professional development.
• 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, ensure they are correctly completed and indexed, avoid duplication and confirm pre‑approval where required.
• Adhere to policies and procedures and take corrective action where necessary.
• Ensure all risks are mitigated and escalated where necessary.
• Understand medical conditions and their implications on functional ability, especially relating to job requirements.
• Understand and possess knowledge of the group insurance industry.
• Appreciate future trends within Employee Benefits.
• Keep knowledge of current legislation relevant to the industry.

As an applicant, please verify the legitimacy of this job advert on our company career page.