Claims Assessor

Momentum Metropolitan Holdings, formerly MMI Holdings, is a South African-based financial services group was established on 1 Dec 2010, through the merger of Metropolitan and Momentum. We are specialists in long and short-term insurance, asset management, savings, investments, healthcare administration, health risk management, employee benefits and rewards programmes. Our purpose is to enhance the lifetime financial wellness of people, their communities and their businesses wherever they may be in the world. Our strategy is simple to build relationships with clients by integrating financial wellness solutions into each and every engagement we may have with them. We want to understand their needs, circumstances and preferences and design holistic lifetime solutions with a personalised suite of products and services that sees to the financial wellness of the individual. At work, we strive to have a culture that is grounded in accountability, diversity, excellence , innovation, integrity and teamwork. Since we are in the business of people, we do not consider Corporate Social Investment as a nice-to-have, but as an imperative to help alleviate some of the challenges we face as a society. We are proud to proclaim our workforce a collective of social givers; employees lend their time, might and money to various projects to uplift and grow the community. MomMet has gone from strength to strength boasting an impressive 16 000 employees, six operating brands; the Multiply rewards programme; specialist cell captive insurance group Guardrisk, healthcare group Carecross, Occupational Care South Africa, property management group Eris and mobile health provider Hello Doctor. Weve also made inroads into the global investment space in the UK through Momentum Global investments. And we are now one of the largest insurers listed on the Johannesburg Stock Exchange (JSE) Role Purpose To be part of a team that provides market leading claims assessment capability for living benefits (critical illness, income and disability benefits). This will include specialising in income disability, lump sum disability,critical illness and case management for living benefits, the completion of quality industry assessments within the required service levels. Requirements B./BSc. Occupational Therapy, Physiotherapy or Psychology or Qualified Registered Nurse or other health sciences related degree considered appropriate. 1-3 Experience in life insurance claims. Relevant insurance knowledge, applicable regulatory requirements and legislations (beneficial). Experience of general retail protection market product offerings (beneficial) Duties & Responsibilities Execution of the claims assessment methodology across Critical Illness, Income Protection and Lump Sum Disability benefit lines. Approves or declines claim submissions without supervision within company guidelines. Support team members with best practice techniques,medical practice through knowledge sharing. Selects and accepts major risks on behalf of the company, evaluating proposals rather than mechanistic assessment. Assist with the overall improvement of risk management within the living benefits assessment area. Continuous development and application to ensure successful execution of the new claims assessment methodology, including: Current best industry and company practices. Claims research. Technological enablers. Embedding and applying established practices to ensure consistent application of these in the claims assessment environment. To partner and collaborate with both internal and external stakeholders, not limited to product development, underwriting, CMO, reinsurance partners to improve claims assessment and client experience. Ensure that assessment methodology and execution is in line with legislation and best practices within the financial management field in order to optimise the claims assessment service offering and deliver. Familiar with 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. Risk opportunity identification to prevent fraud and to deliver quality work. Build and maintain relationships with internal stakeholders responsible for the primary client. Build and maintain relationships with internal stakeholders responsible for the primary client and advisor interactions (claims consultants). Follow internal client service practices which build rewarding relationships and enables exceptional client service Contribute to a client service excellence culture which builds enduring relationships and allows team to provide exceptional client service. Incorporate internal assessment feedback into the enhancement of daily business processes and management operating systems. Act in a way that allows for a positive work climate and culture with fellow employees Competencies Business acumen. Client / Stakeholder commitment. Assertiveness. Drive for results. Diversity and inclusiveness. Collaboration and team work. Impact and influence. Results and solution focused. Self-awareness and insight. Diversity and inclusiveness. Closing Date 2026/09/13