|Location||Dainfern, Gauteng, South Africa|
Supervise the Direct Life and Direct Funeral claims team, enabling the team to
manage risk by paying valid claims, and declining invalid or fraudulent claims.
|Job Functions||Client Services|
-Review the claims assessment, and approve/decline or refer for further
-Ensure that a client policy is valid through the appropriate due diligence (such
as listening to the policy sales/retention etc. phone conversation).
-Ensure that relevant waiting periods have expired and that all premiums have
been received on the policy.
-To appropriately escalate any red flags / discrepancies to the relevant
department (for example forensics) as and when identified.
-Adhere to SLA's between claims and the other relevant department.
-Supervise others working within established operational systems.
-Ensure that the assessors capture the correct banking details and correct
amount of an accepted claim is paid to the appropriate parties.
-Ensure that the assessor forwards appropriate settlement documentation to the
-Ensure that the assessor provides communication to the relevant parties for a
declined claim and the reasons for the claim being declined is explained
Insights and Reporting
-Identify the problems and investigate the cause thereof and report on these
-Report on claims pending, received, declined and approved on a weekly and
- Report on weekly targets achievement.
-Conduct claim audits on a monthly basis and assist with management/board
-Review and provide feedback on new products and processes.
-Ensure that all appropriate documents are in place relating to a claim.
-Ensure that the correct decision is made with regards to acceptance/declining
payment of claim based on appropriate documents received and relevant
contract in place.
-Ensure that production targets are met and that relevant
turnaround times and SLA's are adhered to.
-Help manage clients by carrying out standard activities and providing support to
-Ensure that the assessors keeps the claimant informed at all times with
regards to their claim process.
-Ensure that escalated queries and complaints are resolved in a timely manner.
Project and Program Stakeholder Engagement
-Liaise with internal and external (for example Ombudsmen; Broker's; Lawyers
etc) stakeholders on customer complaints and queries regarding outcome of
-Provide the internal and external stakeholders with comprehensive feedback on the background of the claim and decision made.
-Leverage all available information from our partners, the industry, and internally
to ensure we are constantly reviewing our departmental processes, systems and
protocols with a view to improve efficiencies.
-Analyse current performance inhibitors and finding solutions to ensure business
-Respond to personal objectives and use performance management systems to
improve personal performance. Take career development and performance
management seriously (look for ways to improve competence/results).
-Monitor the performance of the team; allocate work and review completion, take
appropriate corrective action to ensure timeliness and quality; contribute to
formal individual performance management and appraisal.
Organizational Capability Building
-Provide training and coaching to team members to develop their skills.
Motivate team to achieve business goals.
Personal Capability Building
-Develop own capabilities by participating in assessment and development
planning activities as well as formal and informal training and coaching.
-Develop and maintain an understanding of relevant technology, external regulation, and
industry best practices through ongoing education, attending conferences, and
reading specialist media.
Verbal and Written Communication
-Use clear and effective verbal and written communications skill and provide
technical guidance when required to express ideas, request actions and
formulate plans or policies.
-Excellent business writing skills; Excellent Verbal Communication Skills..
-Identify, assess, prioritize and manage risks in a production process and provide
technical guidance when required.
-Ensure that valid claims are paid within SLA.
Policy and Regulation
-Provide technical guidance when required to interpret and apply knowledge of
laws, regulations and policies in area of expertise.
-Knowledge of FAIS, FICA and PPR.
Policy and procedures
-Provide technical guidance when required to develop, monitor, interpret and
understand policies and procedures, while making sure they match
organizational strategies and objectives.
-Knowledge of Life Insurance Principles; Upholds ethics and values and
Customer Service Delivery
-Provide technical guidance as needed on meeting high customer service
-Provide technical guidance when required when using appropriate analytical
processes and procedures.
-Root causes analysis, and formulation of possible solutions.
-Provide technical guidance when required to create relevant, lucid and effective
-Support business processes by understanding and effectively using standard
and niche office equipment and standard and niche software packages, while
providing technical guidance as needed.
-Proficient in Microsoft Office.
Planning and Organizing
-Provide technical guidance when required to plan, organize, prioritize and
oversee activities to efficiently meet business objectives.
-Provide technical guidance when required to develop appropriate plans or
perform necessary actions based on recommendations and requirements.
Data Collection and analysis
-Provide technical guidance when required to analyze data trends for use in
reports to help guide decision making.
Learning and Talent Development
-Provide technical guidance when required to motivate all employees to learn,
grow and develop so that they can obtain the knowledge and experience they
need to help the organization reach its goals.
-Provides staff with development opportunities (coaching, mentoring, training
etc.); Sets appropriate standards of behaviour and build and support retention
-Use an understanding of numerical concepts to perform mathematical
operations such as report analysis.
Grade 12/SAQA Accredited Equivalent (Essential); A FSCA recognized
qualification (Essential); Regulatory exam 5 (Essential); Intermediate Medical
knowledge (Essential); Class of Business and RE1 (Advantageous)
4 or more years life and disability claims assessing experience in the long-term
insurance industry (Essential)
3 or more years experience of supervising and directing people and other
resources to achieve specific end results within limited timeframes (Essential)
ADDITIONAL INFORMATION SAQA Accredited Equivalent - It is the onus of the applicant to provide TIH and
its subsidiaries with certified evidence that their qualification(s) meet the
equivalent NQF level required for this role at time of application. As a registered
Financial Service Provider, we are mandated to ensure that all our
representatives are and remain fit and proper at all times. By applying for this
role, you consent to having your relevant qualification and or accreditation or
confirm that you are working towards meeting the competency requirements.
You further consent to the relevant information being verified.
|Job Closing Date||29/01/2021|