Job Opportunities at FEM

Job Description

• Applicants are invited to apply for the Quality Assurance Analyst position in Head Office. Reporting to the Quality Assurance Manager, the primary purpose of this role is to ensure that claims operations and policy administration areas within FEM conform to regulatory and operational requirements from inception to finalisation.  The primary focus of this role is the early identification and reporting of control weaknesses and process deficiencies to mitigate risk and ensure adherence to operational and were applicable, financial best practices.

The successful candidate will be responsible for:

• Conducting divisional quality assurance reviews by assessing potential risks and non-compliance with prescribed rules, procedures and standards of quality,
• Reporting and analysis of all reviews completed,
• Identifying training needs based on findings,
• Preliminary investigation of suspected fraud cases,
• Updating the Operational risk register,
• Analysing reports received from the Board of Healthcare Funders to identify the impact on FEM claims,
• Engage with internal stakeholders including the legal, risk and compliance functions.

The minimum requirements of the position are a Matric with a least 3 years’ experience as a supervisor or team leader in a disability claim or policy administration related environment. Certification in COIDA Total Quality Management or Auditing are an added advantage. Sound knowledge and understanding of COIDA insurance claims and policy administration operations and related risk management are requirements for the position. Excellent customer focus, the ability to work in a highly pressurised environment, quality orientation, reliability, report writing, and excellent communication skills complete our requirements. 

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• FEM is looking to appoint a Claims Manager reporting to the Head Office Claims Manager to oversee and manage a team that processes claims received in accordance with the (Compensation for Occupational Injuries and Diseases Act) COID Act and FEM’s standard operating procedures. The successful candidate will be responsible for the planning, organising, and managing f the claims department. The incumbent will implement and develop strategies and goals and assess overall performance of human resources to ensure compliance and efficient delivery on objectives relating to management reporting, audits and the risk profiles.
• Furthermore, the incumbent will provide service excellence by ensuring claims turnaround times are met. Similarly, to interpret and apply all benefits as prescribed by the COID Act and ensure that the department complies with the statutory requirements and all other relevant legislation. The incumbent is also expected to travel to stakeholders and provide training to the Policy Holders and Medical Service Providers.
• The minimum requirements of the position are a B degree in Nursing or equivalent and a management related program. The position requires a minimum of 10 years work experience in a clinical environment , 3 years in disability claims environment and at least 3 years’ experience in a supervisory/ management capacity.   Further requirements are knowledge of the COID Act, a good understanding of the risk management processes, own transport with a valid driver’s license and good computer skills, the ability to work within strict deadlines, reliability and excellent communication.

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Job Description

• Applications are invited for a Risk Manager position in Head Office. Reporting to the Senior Risk and Compliance Officer, the primary purpose of the position is to lead and embed the risk management framework at an enterprise level.

Responsibilities:

• Providing second line oversight and challenge over all aspects of risk management, including risk identification, assessment, management, monitoring, and reporting
• Developing and implementing the Risk and Control Self-Assessment (RCSA) process
• Reviewing and updating Key Risk Indicators, risk registers, risk appetite targets and metrics
• Owning the incident management process and actions tracking, this includes operational incidents, fraud incidents etc
• Overseeing the Business Continuity Management (BCM) framework
• Drafting risk reports for management and board subcommittees
• Reviewing risk management policies and procedures
• Providing staff training on risk-related matters
• Participating in special projects, committees, and meetings as required
• Assisting the Senior Risk and Compliance Manager with various tasks as needed
• Implementing a risk management system

Education and Experience Requirements

Minimum:

• Bachelor’s Degree  (or equivalent), Post Graduate Diploma/ Honours Degree with more than + 8 years’ risk experience and registered with Institute of Risk Managers South Africa or
• Risk Management/ Risk Relevant degree with + 8 years’ experience.  of relevant experience in enterprise risk management or related fields
• Experience with building risk management frameworks

Preferred:

• Recognised enterprise risk management designation or education
• Member of the Institute of Risk Management South Africa (IRMSA)
• Experience with deploying risk management software

Skills and Abilities

• Strong oral and written communication skills
• Ability to communicate effectively with stakeholders at all levels
• Ability to deliver results on a timely basis
• Ability to work autonomously within a hybrid work environment
• Advanced analytical and problem-solving skills
• Ability to identify and resolve technical, operational, and organisational issues
• Ability to manage multiple tasks and projects simultaneously, including the ability to handle changing priorities
• Ability to foster a risk-aware culture
• Ability to learn quickly and establish relationships with key stakeholders
• Strong PC and technical skills, including spreadsheet and presentation software

Knowledge and experience:

• Development and implementation of operational risk management framework including risk and control self-assessments and key risk indicators
• Incident management
• Business continuity management
• Microsoft Office Suite - Advanced
• Stakeholder relationship management
• Knowledge of ISO 31000
• Combined assurance
• Experience with risk management systems (e.g. Cura /other)
• Knowledge of the Insurance Act and COID Act
• Knowledge of ISO 31000
• Knowledge of GOIs issued by the Prudential Authority that are risk related