Group Benifits Operation Specialist at Sanlam Private Wealth

Job description

Position Details

Position Description Key Responsibilities

• Ensure that the claims team adheres to the claims processes as specified in the standard operating procedures and policies. Ensure that all criteria are met to pay valid claims by assessing and authorising all claims before finalisation.
• Ensure that the team provides clients with real time information on the status of the claims and policy changes, in line with Treating Clients Fairly policy of Sanlam and Legislation.
• Ensure that all invalid claims are assessed and correctly repudiated in line with the Sanlam frameworks provided by management.
• Ensure clear communication and updates of claim related information or processes to all servicing offices.
• Ensure that claims are paid within SLA through effective capacity management of available resources
• Ensure that any audit findings (internal/External) are resolved as soon as possible and that additional controls are implemented to reduce the said findings.
• Provide management with daily/weekly and monthly claim reports
• Liaising with internal and external clients
• Identify and report on risks within own area of responsibility which could impact negatively on stakeholders
• Highlight potential risks in other areas which may impact on own area of responsibility.
• Appropriate escalation of claim issues to management
• Managing and authorisation of daily payment runs
• Management and development of Staff (multi-skilling)
• Performing coaching
• Effective delegation of claims to team members / capacity management

(if/when required)

• Reconcile claim registers to bank accounts on a monthly basis
• Sign off on monthly claim Registers and recons
• Own and team’s operational work planning, priority setting and scheduling
• Assist other teams if and when required by management
• Ensure alignment of processes and procedures between own and similar functional areas
• Assist with the investigation of all complaints relating to claims processed by GB and or third parties (Ombudsman etc)
• Other Ad-hoc investigations
• Review and resolve escalated queries received

Minimum Requirements

• Matric is essential
• Advanced Excel
• Minimum 8-10 years in a financial industry experience
• Understanding of Group Benefits processes
• Minimum 5 years claims experience
• Industry and Product knowledge (Specifically Funeral Insurance)
• Long Term Insurance experience
• Supervisory Experience (Advantage)
• COP (Advantage)

RE5 ( Advantage) Competencies

• Client Service Orientation in line with Sanlam Treating Clients Fairly policy
• Understanding of Group Benefits processes & Legalities
• Accuracy
• Confidence and Decisiveness
• Planning and Organising
• Pro-active
• Good Communication Skill
• Multi –skilled
• Taking ownership
• Coping with pressure and setbacks
• Adapting and responding to change / Flexibility
• Team Management
• Team work
• Self-driven

Positive Attitude