Disability Claim Assessor

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Job Description

Role Overview

The role involves assessing and managing disability claims in line with product and contractual guidelines ensuring holistic evaluations based on medical occupational and other relevant information. The successful candidate will oversee a portfolio of clients providing training education and insights on claims trends while maintaining strong relationships through proactive support. Additionally responsibilities include optimizing processes collaborating with corporate teams managing organizational risks ensuring regulatory and operational compliance and fostering personal capability development through continuous learning and industry engagement.

Key Result Areas

Assess disability claims according to product and contractual guidelines

Performing an holistic assessment of disability claims based on medical occupational and other information received and applying contractual terms and conditions to determine the validity of each claim.

Management of claims in payment

Optimal and timeous management of income protection portfolio of claims in payment which encompasses reviews return to work planning case management and termination of benefits.

Manage a portfolio of clients

Manage a portfolio of clients by providing training education and presentations on claims trends. Deliver regular reports and insights while handling client enquiries efficiently. Build strong relationships through proactive support and effective communication.

Process optimization

Ongoing process optimisation & improvements within the team with a focus on implementing best practice and keeping up with industry changes and trends

Communication & Collaboration

Collaborates effectively with others to achieve team goals. Regular engagement with Corporate teams providing feedback to relevant teams on claims trends. Verbal and written client communication is a daily requirement.

Organizational Risk Management

Keep track of risk parameters identifying any deviations and reporting them to more senior colleagues. Involves working within established risk management systems.

Regulatory and Compliance Management

Investigate standard incidents using current regulatory and compliance processes systems and procedures and take action to solve immediate compliance issues. Advise more senior colleagues on more complex problems.

Operational Compliance

Develop knowledge and understanding of the organizations policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards.

Personal Capability Building

Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology external regulation and industry best practices through ongoing education attending conferences and reading specialist media.

Role Requirements: Skills Qualifications and Experience

• Grade 12/Matric
• Completed medical / allied health Degree e.g. Nursing Occupational Therapy Physiotherapy
• Minimum 2 years clinical experience
• Experience in the Financial Service Industry is advantageous
• Disability Claims assessment experience in a Group Assurance or Risk environment and GAP product knowledge is highly advantageous
• Well developed interpersonal skills
• Strong verbal and written communication skills
• Excellent attention to detail
• Good presentation skills
• Ability to work under pressure to meet deadlines
• Computer literate and proficient in MS Office programmes e.g. Word powerpoint & Excel
• Have sound analytical and problem solving abilities
• Work effectively with internal and external colleagues and clients to accomplish organisational and team goals
• Enjoy working in a progressive environment

Skills

Competencies

Education

Closing Date

The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.

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