Caims Operations Manager at Rand Mutual - RMA

Purpose

• Reporting to the Operations General Manager, the incumbent will be responsible to lead, motivate, develop, and deliver the overall operational performance and optimisation, strategic direction, service excellence and best practice for the claims function.

Qualifications and Experience Required

• Relevant Bachelor’s Degree
• Minimum 10 years management experience within the financial services environment
• Solid experience in long term insurance claims
• Experience in the implementation of business change / optimisation projects
• Additional insurance related qualifications / training will be advantageous
• Additional medical related qualifications / training will be advantageous

Key Areas of Responsibility

• Manage overall claims processing function, and ensure accurate and timely processing of claims within established legal and company compliance guidelines
• Meet and exceed all service level requirements
• Oversee and ensure achievement and maintenance of all claims processing standards within established guidelines
• Ensure compliance with all claims related contractual, regulatory and legal requirements
• Analysis of claims payments and denials to identify and address trends and opportunities
• Identify and implement operational efficiencies and development of ‘best practice’ policies and procedures
• Overall management of complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures.
• Analyse customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met 
• Deal with customer complaints and appeals accordingly
• Drive and manage quality and customer service standards
• Prepare and monitor claims expenses and administration budget
• Provide quality operational leadership
• Contribute towards overall strategy and link to the setting of standards, targets and overall objectives
• Ensure that all business process is followed
• Apply basic statistical analysis to track performance variations and resolve operational performance variations
• Produce and analyse weekly/monthly KPIs, dashboards and analytics to measure and improve performance
• Prepare and present management information and reports as required
• Ensure performance issues are identified and resolved accurately and timeously and implement action plans to proactively manage any foreseeable issues
• Analyse and evaluate business processes and recommend actions to streamline processes, improve operational efficiencies, and identify opportunities for reducing operational costs
• Overall management and effective operation of other service offerings, including pensions and ensure performance, quality, and customer targets within these services are met
• Keep up to date with current statutory regulations and monitoring changes in the legal requirements for other service offerings including pensions providers and developments in pension provision
• Work with the Support Services Manager in the preparation of audits and ensure compliance with all audit requirements
• Work with the Support Services Manager and Quality Assurance Team to ensure controls to prevent and eliminate fraud are in place at all times
• Work with the Support Services Manager and Investigator on complex or fraudulent cases and provide specialist knowledge where appropriate
• Represent the department in meetings with internal / external stakeholders
• Build strong business relationships with key clients and stakeholders
• Work with key stakeholders to improve performance of the department
• Update job knowledge through the studying of trends and developments in claims processing
• Manage team measures and incentive criteria
• Proactively identify and manage personnel problems to ensure engaged workforce
• Implementation of performance management standards to ensure high calibre team
• Bring expertise, experience and skills and assist with continual training, coaching, mentoring, development, empowerment and performance of claims team.
• Drive an empowered and engaged high performance culture focused on continuous improvement and service delivery
• Live the RMA values
• Implement world class engagement strategies to develop and maintain the reputation of RMA being an employer of choice

Knowledge, Skills and Competencies

• Dealing with complexity
• Strategic planning
• Problem solving
• Effective Decision Making
• Achievement Oriented
• Purposeful Communication
• Customer focused
• Excellent interpersonal relationship skills
• Excellent organisational and leadership abilities
• Effective communication
• Ability to interface with stakeholders
• Ability to Delegate
• Ability to work under pressure
• Relationship Management
• Attention to detail
• Process Improvement
• Analysing information
• Time Management
• Interpersonal skills
• Good communication skills (oral and written)
• Strong organisational ability and skills
• Presentation skills
• Proficient in MS Office