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25 Feb 2022

Full-Time Technical Claims Specialist

Sheila Gauteng

Job Description

Closing Date2022/03/11 Reference NumberMMH220208-16 Job TitleTechnical Claims Specialist Position TypePermanent ClusterMomentum Life: Retail Life Insurance Remote OpportunityNone of the time Location – CountrySouth Africa Location – ProvinceGauteng Location – Town / CityCenturion Introduction

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations.

We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities and businesses. Visit us at

Role Purpose

To apply best-practice methodologies in the designing, training and monitoring of the effectiveness of claims assessing within the claims team and ensure optimal technical skills development of the claims assessors and other relevant role players.


Experience and Qualifications
Degree in Health Sciences (Occupational Therapy, Physiotherapy, Psychology) highly recommended.
5+ years’ experience in life insurance claims.
Relevant insurance knowledge and knowledge of applicable regulatory requirements and legislations (required).
Duties & Responsibilities
Assist with development and execution of an industry renowned claims assessment methodology across Death, Critical Illness, Income Protection and Lump Sum Disability benefits through continuous development interventions primarily for assessors based on current best industry and company practices and technological enablers.
Ensure that assessment methodology and execution are 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 individuals to ensure the correct skills, knowledge and behaviours are 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 needs, training and development in order to improve assessor’s skills.
Recommend training opportunities (formal and informal) aligned to assessor/team 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 and other role players to improve outcomes 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.
Give input about 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.

Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
Anticipates, meets and exceeds client’s needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
Drive a sense of urgency, focus, accountability, agility and execution to deliver business outcomes.
Actively leads change, does what is right for the business and drives continuous improvement and efficiencies through innovation.
Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, and empowerment in others and encouraging them to contribute to the best of their ability.
Prioritises the business interests of MM and invests in the success of the group by aligning effort across divisions.
Persuades, convinces, influences and inspires others, both within MM and externally to win support, loyalty and gain commitment to the purpose of MM.
Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
Takes responsibility for own development; and actively mentors, coaches and develops talent in others. Builds leadership bench strength for MM by providing opportunities and experiences to develop skills, competencies and business knowledge.

How to Apply

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Job Categories: WordPress. Job Types: Full-Time. Job Tags: Technical Claims Specialist.

Job expires in 82 years.

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