Job Openings at 1 Life Insurance

RESPONSIBILITIES

Claims Data Collection & Analysis

• Ask questions, collect data from a variety of sources, analyse information and investigate claim. Ensure that the client policy is valid through the appropriate due diligence (such as listening to the policy sales/retention etc. phone conversation.
• Medically assess the validity of the claim by applying specialist medical assessing skills and knowledge. Ensure that relevant waiting periods have expired and that all premiums have been received on the policy. Ensure that the correct decision is made with regards to acceptance/declining payment of claim based on appropriate documents received and relevant contract in place.

Correspondence

• Ensure that a claimant is kept always informed with regards to their claim process. To ensure that the appropriate settlement documentation is sent to the appropriate parties outlining the amounts paid and the reasons for it; and ensure that the relevant parties for a declined claim are contacted and the reasons for the claim being declined is explained thoroughly. Ensure that relevant claims correspondence is forwarded to the reinsurer.

Customer Management

• Help manage customer by carrying out standard activities to complete the customer request. Provide feedback to the complaints department on customer complaints and queries regarding outcome of claims decision. Comply with current claims policy and procedures and ensure that production targets are met and that relevant turnaround times and SLA's are adhered to. To appropriately escalate any red flags / discrepancies to the relevant department (for example forensics) as and when identified.

Administration

• To ensure that the correct banking details are received and captured and that the correct amount in terms of an accepted claim is paid to the appropriate parties. Ensure that all appropriate documents are in place relating to a client policy and ensure that the appropriate disclosures were made by the life assured. Ensure claims statistics are updated correctly and timeously and that all internal and external communication regarding the claim is stored on the relevant folder.

Continuous Improvement

• Leverage all available information from our partners, the industry, and internally to ensure we are constantly reviewing our departmental processes, systems and protocols with a view to improve efficiencies. Analyse current performance inhibitors and finding solutions to ensure business continuity.

Personal Capability Building

• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

General Education

• Grade 12/ SAQA Accredited Equivalent (Essential)
• Recognized FSCA qualification (Essential)
• Regulatory exam 5 (Essential)
•  Nursing/relevant medical qualification (Advantageous
•  Class of Business Certification (Advantageous)

EXPERIENCE

General Experience

• 2 or more years claims assessing experience in the life insurance industry (Essential)
• Experience in a medical environment (Advantageous)

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RESPONSIBILITIES

Actuarial Modeling

• Develop, maintain and implement actuarial models and processes.
• Models to be fit for purpose and able to estimate the reality accurately.
• Models (and any form of estimation) to be clearly documented with the scope of use, definitions, data, and assumptions made.
• Monitor models to ensure model performance and that they are communicated back to the business.
• Assess business implications and make recommendations to ensure compliance with IFRS 17 (where the standard allows for discretion).

Stakeholder Engagement

• Collaborate with internal (Actuarial) and external (Business) stakeholders.
• Keep stakeholders informed and up to date with project/analysis delivery and provide clear and concise feedback to stakeholders. Maintain measurable service levels on business requests and provide feedback that speaks to the business issue observed. Be on time and prepared for meetings with Business.

Model deployment and testing

• Plan and deliver the group IFRS 17 project requirements and manage the team on a day-to-day basis to meet project timelines to ensure quality. Ensure peer review of the IFRS 17 models is performed.
• Analyze the results, to ensure the model is performing as expected and producing the results required. Effective impact and sensitivity analysis to be performed before any deployment is done. Translate results from the impact/sensitivity analysis to Business, to provide insight and what various pricing/product changes will mean to profitability and policy growth.
• Maintain and develop documentation on model for pricing/product and clearly state what needs to be deployed and how testing will be done to ensure the deployment is successful. Ensure monitoring process are in place to measure the performance of the model for pricing/product.

Data Collection & Analysis

• Use data from a wide range of sources to analyse key themes and identify possible impacts on the business.
• Extract data used for actuarial models.
• Data/information to be reconciled against credible data sources (for example financials) to ensure the data is complete and accurate.
• Ensure definitions and assumptions are aligned to the problem statement.

Insights and Reporting

• Ensure status updates are communicated to the relevant stakeholders.
• Translate the monitoring results so they can be understood by Business.
• Provide an ecosystem where data and data analysis is nimble and easy to access by any team member. Provide insights to inform the Business of future modelling endeavours. Ensure reports are accurate and complete and regularly validated against credible data sources. Review of results on a regular basis and ready to be presented to the Actuarial Senior Management level.

Project Management

• Deliver small-scale or medium-scale projects while working within an established program management plan. Meet project deadlines of the group IFRS 17 project team.

Improvement / Innovation

• Review existing operations in own area of work and implement innovation processes to generate new ideas and ensure continuous improvements are delivered.
• Stay up to date with Business developments and develop solutions proactivel within Business. Continuous development/research of modelling techniques and feature engineering to improve model estimates.

Leadership and Direction

• Communicate the local action plan; explain how this relates to the function's strategy and action plan and the broader organization's mission and vision; motivate people to achieve local business goals.

Performance Management

• Develop and propose own performance objectives; take appropriate actions to ensure achievement of agreed objectives, using the organization's performance management systems to improve personal performance. OR Manage and report on team performance, set appropriate performance objectives for direct reports or project / account team members and hold them accountable for achieving these, taking appropriate corrective action where necessary to ensure the achievement of team / personal objectives.

Building Capability

• Work within existing development framework to build own capabilities and those of direct reports. Provide specialized training or coaching to others throughout the organization in area of expertise. Mentoring and coaching of junior staff on a technical and professional front.

Operational Compliance

• Identify, within the team, instances of non-compliance with the organization/ actuarial policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these and escalating issues appropriately. Maintain standards of integrity and professionalism as set out by the Actuarial Society of South Africa.

General Education

• Bachelors / Honours degree in Actuarial Science or similar (Essential)
• Passed all CT exams and CA1 (Essential)

EXPERIENCE

General Experience

• 5 or more years’ experience within the long-term insurance industry (Essential)
• Prophet experience (Essential)
• Experience in IFRS 17 model building (Essential)

Managerial Experience

• 2 or more years’ experience of supervising and directing people and other
• resources to achieve specific end results within limited timeframes (Essential)