Manager: Claims

Role Purpose

Manage teams responsible for the delivery of claims processes, ensure all relevant policies and procedures are followed, and relevant regulations are adhered to.

Requirements

• Grade 12 or equivalent qualification. (Essential)
• Relevant Bachelors Degree or equivalent qualification. (Desirable)
• 5-7 years’ claims experience in the financial services industry (Essential)
• 2-3 years’ people management experience (Essential)
• Knowledge of claims policies, procedures and processes.
• Knowledge of business products and associated rules.
• Knowledge of all business-related rules and regulations, e.g. FAIS, JSE, Industry regulations etc.

Duties and Responsibilities

Internal Process

• Ensure all required reporting is completed accurately on a daily, weekly and monthly basis.
• Manage daily workflow and lead effective resource planning to ensure business continuity.
• Manage the implementation of standard operating procedures, quality and service standards.
• Monitor and evaluate claims processes for quality and effectiveness and adjust as required.
• Implement and monitor the application of good governance principles, Treat Customers Fairly (TCF) principles and legislative compliance.
• Review performance targets in line with business objectives and realities to ensure optimal performance is maintained.
• Create, implement and ensure compliance to the relevant Service Level Agreements (SLAs).
• Drive continuous improvement initiatives to drive efficiencies and improve client experience.
• Drive and monitor team up-skilling to address product knowledge gaps.
• Manage escalation process to resolution, identify opportunities for improvement and resolve any issues.
• Identify system inefficiencies and drive the resolution process with other internal stakeholders.
• Establish productive operational relationships with key stakeholders in the various channels and administrative teams.

Client

• 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.
• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall client targets.
• Provide authoritative, expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Contribute to the process of negotiating objective and realistic service level agreements, monitor appropriateness and recommend adjustments.
• Deliver on service level agreements made with 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.

People

• Create a positive work climate and culture to energise employees, give meaning to work, minimise work disruption and maximise employee productivity.
• Demonstrate exemplary leadership behaviour, through personal involvement, commitment and dedication in support of organisational values.
• Select and recruit suitably qualified talent in line with Employment Equity principles and Momentum Metropolitan values.
• Drive a culture that guides and directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
• Enable a learning and growth culture whereby information regarding successes, issues, trends and ideas are actively shared between team members.
• Execute effective workforce planning practices to ensure that staffing requirements are accurately forecasted.
• Identify employee growth and development needs and schedule interventions to enable ongoing development, training and personal growth.
• Effectively manage performance within the team in order to ensure business objectives are achieved.
• Encourage innovation, change agility and collaboration within the team.

Finance

• Contribute to continuous improvement efforts by the identification of opportunities, management of risk, cost reduction, improvement on the quality of claims decisions, service and systems enhancement.
• Implement risk management, governance and compliance policies in own practice area, to identify and manage governance and risk exposure liability.
• Investigate reported wilful acts of non-compliance to organisation policy and practice and report on findings.

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