Claims Specialist

Introduction

Through our client-facing brands Momentum Group, 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.

Disclaimer

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Role Purpose

Deliver accurate and timely claims administration by interpreting benefits, adjudicating claims, resolving complex queries and maintaining compliant, ISO-aligned processes.

Requirements

• A National Senior Certificate is essential
• Relevant tertiary qualification in Healthcare Administration or Business Administration is advantageous
• 2–3 years’ Experience in a medical scheme claims processing environment is essential
• Experience handling complex claims queries and MVA claims is advantageous
• Knowledge of medical scheme rules and regulations
• Proficiency in MS Office Suite (Excel for reporting and analysis)

Duties & Responsibilities

• Resolution of a wide range of escalated queries
• Scheduling and analysis of various reports
• Manage all Motor Vehicle Accident (MVA) claims processes, including case documentation, attorney correspondence, record maintenance, and preparation of reports and spreadsheets.
• Assist with scheduling of claim payments and related administration
• Drive exceptional stakeholder experiences by building strong relationships, understanding needs, delivering timely, high-quality service, and continuously improving processes for efficiency and client-centricity.
• Foster an engaging, collaborative, and growth-oriented work culture by promoting teamwork, continuous learning, innovation, and personal development.
• Ensure compliance with ISO QMS standards by implementing, monitoring, and continuously improving processes.

Competencies

• Examining information
• Making decisions
• Following procedures
• Interpreting data
• Developing expertise
• Checking things
• Communication skills (written and verbal)