Group Schemes Claims Assessor - Johannesburg, South Africa - Absa Bank Limited

Absa Bank Limited

Verified Company

Johannesburg, South Africa

1 week ago

Posted by:

Thabo Mthembu

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Description

Bring your possibility to life Define your career with us

With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.

Job Summary

To provide and maintain a consulting service to employers, retirement funds and other stakeholders with regard to employee benefit risk management and incapacity management in the workplace.

This includes advice on benefit structures and management of ill or disabled employees in the workplace

Job Description:

Assessment of disability claims

Analyse the claimant's medical condition, vocational requirements as well as fund/insurer rules and policies to determine the eligibility for benefits.
Consider the relevant Fund/Insurer rules and policies to determine a member's eligibility for benefits e.g., determine if the members medical condition was preexisting
Evaluate the extent of a member's disability against his/ her occupational duties
Assess and Compile a recommendation on the validity of the claim to be submitted to the client in a written report
Manage appeals arising by reviewing claim documentation against issues that are either medical and/or legal in nature. This includes determining and sourcing of new medical evidence and/or technical information and reevaluation in terms of the rules of the Fund
Provide medical and technical recommendation to the relevant Fund trustees

Consulting to clients on claims

Respond to product queries from members and clients on claims and the related decisions and outcomes of these
Provide suggestions and advise to clients on the management of individual claims
Provide suggestions and advice to clients on the management of the claims
Discuss the disability reports with clients in order to identify trends and issues of concerns and provide recommendations on interventions

Authorisation of member risk benefits

Compilation of claim decision letter in terms of the medical, legal and financial outcome of the claim.
Authorise payment of claims and medical accounts received from medical and paramedical practitioner

Reporting on claims

Provide management information to clients on trends and statistics related to claims
Ensure that the reports are sent to the clients according to the SLA's in place

Disability Management

Determine cases that require disability management based on medical diagnosis and prognosis
Implement and monitor disability management programmes for all designated cases by obtaining feedback from relevant rehabilitation practitioners
Assess viability, costs, duration and outcome of disability case management
Recommend claimant return to work in their own role; a modified or completed alternative role; or submit for long term disability. Consult with line management to assist in finding a suitable alternative role for the claimant

Education

Higher Diplomas:
Business, Commerce and Management Studies (required)