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  • Posted: Jul 14, 2020
    Deadline: Not specified
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  • Note: Never pay any money to any recruiter for any purpose (certificates, medical testing, interview, work kit or any other thing).

    • RMA in a nutshell Identifying a need to help care for miners who were injured while on duty, Rand Mutual (RMA) was founded in 1894 by three mining companies on the Witwatersrand as a non-profit mutual assurance company. Today RMA has grown to offer workmens'​ compensation benefits to the mining, iron, metal, steel and relate...
    Read more about this company

    ICT Test Analyst

    PURPOSE

    • Reporting to the ICT Testing Team Leader, the ICT Test Analyst will be responsible for developing Test Plans and conducting testing of systems according to test plans.

     

    QUALIFICATIONS AND EXPERIENCE REQUIRED

    • NQF Level 6: Diploma in Information Technology
    • At least 3 - 5 years’ experience of developing system test cases
    • At least 3 - 5 years’ experience of system testing
    • Thorough understanding of system testing methodologies
    • Good working knowledge and understanding of computer systems and technologies
    • Ability to interface with users, IT Developers, management and external IT Services providers
    • Excellent verbal and written communication skills

     

    KEY AREAS OF RESPONSIBILITY

    Develop and implement test plans

    • Develop Test Plans
    • Conduct testing of systems according to test plans
    • Log identified defects on the defect tracking system, assigning the relevant severity and priority
    • Monitor the progress of defects and the number of defects being logged back to ICT
    • Retest defects corrected until customers have signed off

    Provide support and training for users and stakeholders

    • Develop relevant application training programs for users
    • Conduct application training for users
    • Create training material for users
    • Train and support users on the use of application systems
    • Assist and guide users in the test of systems
    • Assist ICT Developers with the understanding of the systems where required
    • Assist with the analysis and functional specification of the systems

     

    KNOWLEDGE, SKILLS AND COMPETENCIES REQUIRED

    • Knowledge of business policies, processes and procedures, legal compliance
    • Service Orientation / Customer Responsiveness
    • Stress handling
    • Teamwork/collaboration
    • Self-Management
    • Rule-orientation
    • Planning, Organising and Follow through
    • Decisiveness and Action Orientation
    • Resilience / Optimism

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    Actuarial Analyst

    Purpose of the Role

    • Reporting to the Senior Actuarial Analyst, the incumbent will support the actuarial function in preparing monthly valuations, EXCO reports, building financial models, determining capital requirements, pricing and product development.

    Qualifications and Experience required

    • Bachelor’s degree – Actuarial Science
    • Progress towards actuarial exams – 3 CT exams
    • At least 2 years of experience in an actuarial capacity
    • Previous life and short-term insurance valuation or insurance risk management experience would be an advantage

    Key Areas of Responsibility

    Direct

    • Preparation of the monthly valuation results
    • Ensure valuation data integrity
    • Preparation of actuarial specific areas in all the Group regulatory returns (Monthly, Quarterly, Annual)
    • ORSA and SAM reporting
    • Maintaining actuarial data
    • Timeous response to actuarial queries
    • Maintenance of pricing models
    • Financial projections

    Indirect

    • Build good relationships with internal stakeholders
    • Effective reporting and assessment of problem areas

    Projects

    • Any ad hoc duties

    Knowledge, Skills and Competencies required

    • Communication
    • Decision Making
    • Ethical Work Standards
    • Applied Learning
    • Planning and Organising
    • Analytical (problem solving)
    • Results driven
    • Confidentiality

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    Junior Clinical Claims Adjudicator

    Purpose:

    The Junior Clinical Claims Adjudicator will report to the Claims Management Consultant, the incumbent will be responsible for effectively and efficiently processing pre-authorisations claims for COVID 19 incidents under the Compensation for Occupational Injuries and Diseases Act (COIDA).

    Qualifications and Experience Required

    • NQF Level 6: Diploma in Nursing/Allied Health/related field with additional certification
    • Valid registration with professional body
    • At-least 2-3 years Case Management/ Life Insurance/Medical Aid claims environment experience
    • 2 - 3 years claims and contact centre related experience
    • Additional insurance related qualifications or training (advantageous)
    • Medical Knowledge at NQF6 level
    • Knowledge of administrative and clerical procedures
    • Computer literate - MS Office
    • Knowledge of Customer Service principles and practices
    • Valid Driver's License and own transport

    Key Areas of Responsibility

    • Capturing of COVID 19 claims, following up on outstanding documents from relevant stakeholders and indexing of documents
    • Keep stakeholders informed and updated via various channels i.e. email, telephone, SMS etc. throughout the various stages of the claims processing cycle
    • Servicing stakeholders telephonically and via email by resolving their queries
    • Adjudicating and processing COVID 19 claims in an effective and efficient manner within the prescribed guidelines set out by RMA

    Claims Management (end-to-end management of claims)

    • Acknowledgement of COVID 19 claims upfront
    • Communicate and articulate the claims process and requirements to the claimants and employers
    • Gathering information, and sending follow-ups and reminders on outstanding claims documents
    • Scanning of mail, documents, faxes, documents/images received from clients
    • Identification and editing/correcting legibility of scanned documents
    • Assist in checking the eligibility and validity of the members                      
    • On an ongoing basis, ensure that there are no duplicate documents uploaded on the system
    • Analyse documents received to produce the appropriate shades and best resolution in scanned reproductions
    • Organise scanned documents on the local network

    Claims processing and adjudication

    • Manage COVID 19 claims aligned to treatment protocols and COIDA limits
    • Manage costs associated with the authorisation and claims Estimates for all claims within their space
    • Review and update ICD 10 codes based on First/Progress/Final Medical Reports/Investigation Results
    • Review and update claims close to exceeding their Maximum Medical Improvement (MMI)
    • Refer complex cases to the CCA for opinion and action accordingly

    Capture and process payments for claims

    • Prepare payment file for authorisation
    • Capture and send payment on disease claims for authorisation as received from CCA’s

    Attend to queries related to claims under management

    • Handle all calls related to COVID 19 claims
    • Handle queries related to COVID 19 cases and claims under their control and escalate where needed
    • Maintain desk SLA through adherence to schedules, defined processes and workplan
    • Follow-up on customer calls where necessary
    • Document all call information according to standard operating procedures
    • Complete call logs and issue reference numbers to customers
    • Produce call reports
    • Follow-up on initial contacts to determine customer satisfaction
    • Manage and resolve customer complaints
    • Provide customers with accurate product and service information in an efficient manner

    Knowledge, Skills and Competencies required

    • Knowledge of Claims processing, approval
    • COIDA Knowledge
    • Medical/Financial services knowledge
    • Insurance sector knowledge
    • ICD10 coding
    • Knowledge of customer service principles and practices (Treating Customers Fairly)
    • Good Administrative skills
    • Strong communication skills
    • Computer literate – Intermediate MS Office Suite
    • Deadline driven
    • Client centric personality
    • Attention to detail
    • Self-driven and independent

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    Team Leader Earnings Assessor

    Purpose of the Role

    • Reporting to the Claims Manager, the Team Leader Earnings Assessor will be responsible for supervising and managing the Earnings Assessors to ensure RMA clients are declaring earnings for compensation purposes in line with RMA policies/products and the COID Act.

    Qualifications and Experience Required

    • Matric
    • NQF Level 6: Diploma in Payroll Administration
    • COIDA in Practice or Insurance Qualification an advantage
    • FAIS Regulatory Examination (RE1)
    • Minimum of 7 years supervisory experience within the Insurance/Medical Aid Industry
    • Insurance and/or Medical Aid experience would be advantageous

    Key Areas of Responsibility

    Supervise and manage a team of Earnings Assessors

    • Carry out all team planning on a regular basis, as issues arise, or in advance of anticipated needs
    • Communicate effectively with other teams and management by sharing information on effective practices and needs
    • Monitor and measure the Earnings Assessors’ productivity

    Quality

    • Ensure quality of work is consistently of high standards
    • Addressing and Improving Audit and Quality Assurance findings
    • Ensure high standards of work in line with Quality Assurance metrics

    Manage the earnings function

    • Act as a point of escalation for complex earnings calculations on claims received
    • Ensure timeous calculation of earnings for Temporary Total Disablement and Permanent Disablement; Pensions and Fatal on claims received
    • Ensure timeous management of workflow requests and notifications on earnings calculations

    Compliance to legislation, policies and procedures

    • Ensure adherence to all company policies and procedures throughout the earnings calculations process
    • Always ensure adherence to ethical standards
    • Ensure all earnings calculations are done in line with benefits calculations under legislation

    Reporting

    • Use appropriate templates and channels to report progress on a weekly and monthly basis
    • Adhere to deadlines and timeously submit various periodical reports to Claims Management and internal committees
    • Ensure accuracy and high quality of reports submitted to Claims Management and internal committees

    Innovation

    • Develop innovative methods/procedures of verifying earnings for calculation of compensation
    • Identify opportunities for ongoing system enhancements
    • Work with Data Analytics team to design and implement productivity report and dashboards specifications

    Customer Service

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

    Knowledge, Skills and Competencies required

    • Knowledge of payroll admin processes
    • 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
    • Customer Focus
    • Numerical Ability
    • Process and System Competence

     

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    Claims Manager COID

    Purpose of the role:

    Reporting to the Claims Operations Manager the incumbent will assist in proactively managing claims at the individual and portfolio level while ensuring high quality and achieving high levels of satisfaction for the members, claimants, dependents, and Service Providers.

    The Claims Manager will also assist in ensuring that Class XIII and Class IV Business Claims Teams achieve their operational strategic goals through keeping performance to the highest standards, deliver excellent customer service, while complying with all relevant legislations and all company policies and procedures. The incumbent will also be responsible for leading and supervising the effective and efficient adjudication of COIDA claims.

     

    Qualification and Experience required:

    • Minimum of 10 years supervisory experience within the Insurance industry
    • FAIS Regulatory Examination (RE1)
    • Bachelor’s degree in Administration/Insurance/Health or equivalent OR Medical degree preferably within Occupational Health
    • COIDA in Practice or Insurance Qualification an advantage
    • Computer literacy: Advanced MS Word, Excel and Outlook
    • Good presentation skills and ability to interact with management

     

    Key Areas of Responsibility:

    • Manage claims and administration costs.
    • Proactively manage individual claims from notification to closure.
    • Proactively supervise the proper adjudication of claims.
    • Handle complex and fraudulent claims.
    • Ensure that all payments are correct and in accordance with company and legislative requirements.
    • Feedback claims trends and developments and their potential impact on claims costs.
    • Monitor the medical Management of claims aligned to treatment protocols and COIDA limits and work with the Clinical team to generate Authorization of treatment plans and devices.
    • Management of Cost associated to the authorization and claims Estimates.
    • Ensure that claims are Reviewed and recommendation for TTD Payment, Lump Sum payment or Pension are made.
    • Increase first phase Straight Through Processing of claims and ensure that more than 55% of claims are processed through this system.
    • Participate, provide input and implement “Treating Customers Fairly” within the Department.
    • Identify issues and claims trends in the portfolio, advice Senior Management with recommendation for appropriate and corrective action.
    • Handle client’s complaints and appeals.
    • Taking ownership of client relationships.
    • Build relationships with new and existing clients.
    • Continuous improvement of relationship with clients.
    • Handling and resolving client inquiries related to service delivery.
    • Ensure that customer satisfaction targets are cascaded to all customer facing roles and assessed on a monthly basis.
    • Setting staff performance targets and expectations, ensuring that the targets and expectations are achieved through regular monitoring and management.
    • Ensuring that Claims staff operate within approved claims authority limits.
    • Identify training requirements for staff, through effective staff management and assist them in meeting their training requirements.
    • Develop automated performance and individual performance dashboards
    • Identify key risks indicators and establish mitigating controls.
    • To ensure that expenditure is incurred within the limits of the sanctioned budget.
    • To assist in identifying and recruiting new staff members.
    • Ensure optimal liaison with stakeholders including but not limited to employers, employees and healthcare providers.
    • Management of and participation in Strategic or Operational Projects identified by the Company, within a reasonable time frame and budget.
    • Enhance Business processes, workflows and document system enhancements.
    • Reviewing trends, variances and making changes to improve performance.
    • Ensuring that systems are used effectively to improve accuracy and minimize errors
    • Handling complex complaints or difficult customers.
    • Able to apply sound financial principles and processes to the business and ensure profitability, compliance and continued growth.
    • Use appropriate templates and channels to report progress on a weekly and monthly basis.
    • Adhere to deadlines and timeously submit various periodical reports to Claims Management and internal committees
    • Ensure accuracy and high quality of reports submitted to Claims Management and internal committees

     

    Knowledge, skills and competency required:

    • Knowledge of business policies, processes and procedures, legal compliance and claims environment
    • Knowledge of all related applications and processes relevant to the position of Team leader
    • Knowledge of Claims processing, approval and payment processes
    • Service Orientation/Customer Responsiveness
    • Excellence/quality orientation
    • Judgement and Decision Making
    • Applied Learning
    • Planning, Organising and Follow through
    • Resilience/Optimism
    • Attention to detail
    • Presentation skills
    • Verbal and written communication
    • Interpersonal awareness/empathy
    • Customer Focus

    Method of Application

  • Send your application

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