Claims Approvals Administrator

SUMMARY:
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POSITION INFO:

Purpose of role:

• The ability to check and apply expertise to data with an intended objective to deliver on the specific area of expertise.
• The ability to analyze data and extract trends to ensure improvement of processes and or customer satisfaction. This could be in the form of innovative ideas as well as the task of compiling reports.
• Engage and list current challenges in the team/business and use expertise to Trouble shoot issues to provide workable solutions.
• The ability to tackle a Problem with the intent of using expertise/capability and or experience to resolve speedily.
• Perform quality assurance based on the specialized requirements of the role.
• Should be able to ensure strong stakeholder management ito Communication i.e. feedback to clients, managing clients, responding to clients, attend to queries timeously.
• Engage in a professional manner whether it be verbal or face to face.
• Have the ability to communicate via different communication channels.
• Ensure that the brand or image of SEB is always maintained by adhering to the values (in keeping in line with the KPI and values of the company)
• Be a strong team player.
• Have both industry knowledge and experience.
• Ensure that the role is carried out with the relevant accuracy, attention to detail and following instructions.
• Ensure that judgement and attention to detail is applied to the role.
• Ensure that the role is completed within required deadlines and should have the ability to organize, plan, set goals and deliver accordingly.
• Strong interpersonal skills as cross team collaboration is required.
• Have the ability to innovate in the role.
• Quality of work should be thorough.
• Conscious of the abuse of company resources.

Responsibilities:

• Coordinate and monitor all claim related activities, which include the complete claim processing cycle of all claims, all claim related enquiries or complaints including Pension Fund Adjudicator and FSCA complaints / enquiries.
• Ensure all claims are quality assured and processed according to the rules, policies, legislation, administration procedures / processes and the service level agreements applicable to the Fund.
• Identify, develop, enhance, document and make proposals to implement policies, procedures and processes that are relevant to the claims team, including user acceptance testing of processes on Everest.
• Investigate, analyses and monitor escalations and complaints. Report trends and obtain approval from reporting manager for solutions to implement preventative measures.
• Support a positive and responsive climate for client enquiry resolution, respond to all complaints and enquiries (including PFA and FSCA), and submit response to the complainant / Compliance Team within the service level agreement. Follow through and ensure feedback is provided until resolved.
• Ensure communication, whether internal or external is dealt with professionally and within the service level agreement.
• Be responsible for assisting the administrators with static data changes, roll backs, delegations and adhoc reports.
• Responsible for quality assessing (checking and releasing / audit confirm) of claims.
• Authorize payment of all claims (including funeral, death and disability).
• Accept accountability and take responsibility for tasks done by reporting staff.
• Devote the whole of your time, attention and abilities during working hours to the discharge of your duties with strict accuracy.Build and manage relationships with internal departments, external clients, and service providers.
• The duties include, Approving claims, managing, planning, monitoring and reporting.
• Any other duties as determined by the business needs and to participate in all organizational events as required.
• The duties include, Approving claims, managing, planning, monitoring and reporting.
• Ensure all claims are quality assured and processed according to the rules, policies, legislation, administration procedures and the service level agreements applicable to the Fund to avoid financial risk and PI claims. No significant findings on internal audits 1% error rate, ensure that all claims are managed per legislative requirement.
• Ensure a thorough investigation has been completed on all escalations and enquiries and accurate responses are sent to members, employers and service providers to limit financial risk to business by continuously improving on quality control measures.
• All escalations to be managed within 48 hours – where there is a dependency on other teams’ members to be engaged within 48 hours of process to follow.
• Operational; Claims approver is responsible for the overall management of the allocated claims department team. The duties include, managing, planning, monitoring and reporting.
• Ensure that the claims team achieves the agreed targets weekly, which includes reducing the backlog by 10% per month and authorizing 30-60 claims per day for authorizers with no direct reports.
• All claims to be processed according to the rules, policies, legislation, administration procedures and within service level.
• Manage performance of the team and ensure that all claims paid meet the quality requirements as agreed to and calculated accurately including monitoring and managing team’s workflow reports. Accept Accountability and take responsibility of tasks done by team.
• Compile and provide accurate reports to the reporting Manager, in the required format by the agreed deadlines, to keep management and external stakeholders abreast of progress, delays and or backlog. Compile and complete reports for the Manager.
• Customer: Manage customer relations for SALT Employee Benefits by communicating relevant and accurate information to customer resulting in customer satisfaction.

Relationship Management

• Build and maintain relationships at all levels with reporting staff, all stakeholders and internal departments to enhance organizational effectiveness and efficiency.
• Use your best endeavours to properly conduct, improve, extend, develop, promote, protect and preserve the business interests, reputation and goodwill of the company.

Reporting

• Compile and provide accurate reports to the reporting manager, in the required format by the agreed deadlines, to keep management abreast of progress, delays and or backlogs.
• Assisting and or Responsible for any other reporting as per business requirements.
• Ensure a thorough investigation has been completed on all escalations and finalized within 24 – 48 hours, enquiries within 48 – 72 hours. Follow through and ensure client is provided with on-going feedback until resolved. Monitor escalations and complaints and provide managers with solutions to implement preventative measures.
• Develop claims team staff by mentoring, training, coaching and developing personal growth as a leader within SALT EB.

Required  Knowledge:

• Communication (Written and Verbal).
• Industry knowledge and experience.
• Accuracy and attention to detail.
• Judgement and Decision Making.
• Working under pressure And Deadline driven.
• Organizational skills / Planning and prioritizing.
• Interpersonal skills.
• Settings goals.
• Cross team collaboration.
• Management of time.
• People Management.
• Analysis of data.
• Judgement/Decision making.
• Negotiation and Conflict Management.

Qualifications:

• FICA awareness, POPI & TCF training.
• Diploma in Retirement Funds Management or Equivalent Qualification.
• 5 - 6 years’ experience in the employee benefits / retirement fund industry.
• Extensive knowledge of the Pension Funds Act.
• Extensive knowledge of the Everest system.