Ex Gratia Administrator x3

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.

As an applicant, please verify the legitimacy of this job advert on our company career page.

To prepare cases to be reviewed by the Client's Ex Gratia Committee Board members.

Qualifications

• Grade 12 or equivalent


• Relevant Degree or Diploma in a clinical field (Advantageous)

Knowledge & Experience

• Basic knowledge of claims and reading filters


• 2 - 3 years medical aid experience


• 2 - 3 years client service experience


• Extensive computer experience on Ms Word, Ms Excel and Outlook

Skills

• Excellent communication skills (Written and Verbal)


• Ability to interact with a range of stakeholders in a professional manner


• Client service orientation


• Perform under pressure in a deadline driven environment


• Ability to work independently and to function effectively within a team


• Excellent planning, time management and organising skills


• Strong decision making capabilities

Internal Process

• Perform administrative duties and provide a professional service to members, where special grants
  are requested in cases where medical expenditure, in excess of the Scheme's limits, has caused and or would
  cause financial hardship for members.


• Establish and maintain knowledge of Ex Gratia Guidelines and mandates, Scheme Rules, Benefit Exclusions
  and Claims operational systems.


• Process all documentation received from members, service providers, Managed Care Service providers and
  the Scheme or Principal Officer accurately and timeously and confidentially.


• Record and assesses the Ex gratia Application Form and supporting documentation for completeness.


• Makes telephonic contact with the member to acknowledge receipt of the form.


• In the event of an incomplete Ex gratia Applications and/or outstanding supporting documentation, request the member to send the outstanding documents.


• Perform claims investigation and reconciliations to ensure that all claims are processed correctly, and refer to Claims department for correction where necessary.


• Refer applications to the relevant managed care organisation (MCOs) for validations where applicable.


• Cancel the Ex gratia application as per standard operating procedure (SOP), should the requested information not be received.


• Accurately investigate and prepare Ex Gratia cases for presentation by the Ex Gratia Manager to the Ex Gratia Committee, comprising of the Scheme's Board of Trustees and the Scheme officials.


• Educate and guide members regarding their benefits to enhance understanding and satisfaction with their benefit options.


• Take ownership of escalated and unresolved queries and ensure they are resolved timeously and effectively.


• Ensure the effective, accurate and timeous completion of relevant documentation accompanying applications.


• Provide clear communication to all parties involved in an investigation with regards to the outcomes and process.


• Ensure Service Level Agreements are met and exceeded.


• Maintain high standard of quality ensuring all cases are prepared accurately.


• Provide and maintain accurate and thorough telephonic information to members, service providers and Business Partners regarding queries for claims and general client services relating to Ex Gratia.


• Finalise and communicate meeting outcomes for members and draft outcome letters.

Client

• Build and maintain relationships with clients and internal and external stakeholders.


• Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.


• Make recommendations to improve client service 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.


• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.


• Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.


• Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.

People

• Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.


• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.


• Positively influence and manage change and offer specialist support where required.


• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.


• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.


• Take ownership for driving career development.

Finance

• Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.


• Identify solutions to enhance cost effectiveness and increase operational efficiency.


• Implement and provide input into governance processes, systems and legislation within area of specialisation.


• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.


• Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.