Receives disability claims and assesses payment of benefits in accordance with the rules of the fund and in applying clinical expertise.
Requirements
- BOT (Bachelor of Arts Occupational Therapy) / BSc.OT degree or BSc Physiotherapy.
- Registration with the HPCSA as OT, or Physio
- Minimum 1-year relevant experience.
- Role requires travelling to clients, code B license and own vehicle required.
- 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.
- Knowledge of current legislation relevant to the industry.
INTERNAL PROCESS
- Develop effective relationships with stakeholders at all levels of the organization, including 3rd parties and service providers.
- Monitor customer delivery constraints and escalate exceptions to management.
- Ensure Service Level Agreements are met.
- 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 organizational best practice and legislative requirements.
- Ensure effective claims management service delivery and support.
- Perform an efficient and accurate administrative function.
- Identify and investigate all 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.
- Provide authoritative, expertise and advice to clients and stakeholders.
- Build and maintain relationships with clients and internal and external stakeholders.
- Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
- Managing the client relationship, attend client meetings and facilitate training in respect of claims processes
- Make recommendations to improve client service 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.
- Develop and maintain productive and collaborative working relationships with peers 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
- Identify opportunities 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
