Team Leader Senior Claims Assessor at Rand Mutual - RMA

Description

THE JOB AT A GLANCE

As the Team Leader Senior Claims Assessor, you will be reporting into the Claims Manager. You will be responsible for supervising and managing a team of Senior Claims Assessors who be adjudicating, and processing claims based on Rand Mutual Assurance guidelines.

WHAT WILL YOU DO?

Supervise and manage a team of Senior Claims Assessors

• Assess claims received in line with company policies and standard operating procedures
• Evaluate claims received and determine requirements i.e. medical reports, Statement of Earnings for adjudication
• Evaluate and determine requirements for claims to be presented to RMA Medical staff and Technical Committee for decision making
• Analyse and synopsize medical reports and other information in context of claims
• Supervise and report on the claims process to ensure customers satisfaction, productivity and cost control in comparison with targets set
• Timeous management of Contact Centre enquiries in line with agreed Service Level Agreements
• Ensure adherence to ethical standards and compliance with all Company policies and procedures, as well as regulatory requirements
• Liaise and maintain good relationships with all stakeholders
• Supervise administrative functions relating to the claims process and team functioning
• Deal with the appropriate authorities on all matters regarding the team and claims
• Carry out all team planning on a regular basis, as issues arise, or in advance of anticipated needs 
• Ensure timeous submission of various periodical reports
• Conduct monthly team meetings and individual one on ones
• Communicate effectively with other Teams and management team by sharing information on best practices and needs
• Ensure timeous processing of payments
• Ensure quality of work is of high standard

Process claims

• Manage the claims processing cycle
• Oversee the processing of claims
• Supervise and identify risks relating to employer compliance
• Analyse client trends and report on anomalies and potential risks
• Manage the identification of risks relating to suspicious and fraudulent claims
• Initiate claim investigations and report on fraudulent claims
• Ensure timeous delivery and accuracy of work completed in accordance with stipulated deadlines
• Manage the identification of potential recoveries and reinsurance claims
• Identify potential increased compensation (Section 56) claims and notify Management
• Regularly correspond with stakeholders via email, telephone, face to face interactions etc.
• Authorize payments within authority limits
• Ensure compliance with company policies and standard operation procedures
• Identify and document system defects

Resolve and reduce complaints 

• Manage complex complaints and difficult customers
• Upskill team to resolve complaints quickly and efficiently
• Minimise follow ups, transfers and delays
• Participate in Satisfaction survey

Reporting on progress

• Use appropriate templates and channels to report progress on a weekly and monthly basis
• Adhere to deadlines and ensuring accuracy and quality

Customer Service

• Manage and Ensure customer service is of high standard
• Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
• Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
• Manage walk-in queries as and when required
• Handle customer inquiries both telephonically and by email
• Provide customers with accurate product and service information in an efficient manner
• Deal with all customers in a professional and empathetic manner
• Address customer satisfaction issues promptly by conducting a root cause analysis and investigating the source of the dissatisfaction

WHAT YOU'LL BRING TO THE TABLE?  

• NQF Level 6: Diploma in a FAIS Recognised Qualification
• COIDA in Practice or Insurance Qualification an advantage
• A legal qualification will be advantageous
• FAIS Regulatory Examination (RE5)
• FAIS Regulatory Examination (RE5) an advantage    
• Minimum of 5 years’ experience within the Insurance/Medical Aid Industry of which 2 years must be at supervisory level
• Knowledge of COID legislation
• Knowledge of Claims processing, approval and payment processes would be advantageous
• Knowledge of all related applications and processes relevant to the position of Team leader
• Good presentation skills and ability to interact with management
• Computer literacy: Advanced MS Word, Excel and Outlook
• Insurance and/or Medical Aid experience would be advantageous

WHAT WILL YOU GET IN RETURN?

We offer great opportunities for personal and professional development in a stable company that’s 127 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.