Jobs at Guardrisk

Role Purpose    

• Processing of medical expense shortfall (gap cover) claims in accordance with stipulated service levels and in terms and conditions of cover as defined in policy wording.

Requirements    

• Matric 
• Basic medical qualification an advantage (e.g., nursing or similar qualification)
• Computer Literacy (MS Word, Outlook, and Excel)
• FAIS Fit and Proper including RE5
• At least 2 years medical or short-term health and accident insurance claims handling experience
• At least 2 years client servicing experience
• A good knowledge of the local healthcare industry

Duties & Responsibilities    

• Ensuring that the principles and outcomes of TCF (Treating Customers Fairly) are practised and achieved in all duties performed and services provided to Admed customers
• Ensuring the cradle-to-grave coordination of all gap claims received electronically from contracted medical schemes with the objective of achieving an entirely seamless claims experience for mutual customers
• Dealing with client and medical scheme queries as and when they arise within the stipulated timeframe
• Receiving of new Seamless claims via Secured sites and emails, importing them into the system – including the updating of members’ personal details – onto claim administration system on the same day or within 48 hours of receipt
• Ensuring that claims data is successfully received from all contracted medical schemes in the correct electronic format and in accordance with agreed SLA’s
• Ensuring the ongoing successful importing of claims data into the claim administration system
• Interacting with relevant medical schemes via e-mail or telephone in respect of outstanding information or claims documentation, on the same day or within 48 hours of receiving or capturing the claim
• Ensuring that all registered claims are assessed and administered effectively and efficiently in terms of the relevant and prevailing legislation and policy wording
• Accurately and completely capturing the clinical details of a claim on the claim administration system on the same day or within 2 working days of receipt
• Prioritizing claims where outstanding documentation has been received – ensuring that these documents are captured within 48 hours of receipt
• Assessing claims in accordance with practice guidelines, policy wording and protocols
• Finalisation and forwarding of claims to the quality assurance team for approval / rejection
• Ensuring prompt handling and feedback on claims
• Responding to capture queries received within 48 hours of receipt
• Detecting and acting on potential fraudulent claims
• Ensuring a high level of service when liaising with individual and corporate customers, intermediaries, binder holders, Medical schemes and colleagues
• Ensuring that the principles of TCF are delivered across every function performed, with a specific focus on the achievement of TCF Outcome 6 (Customers do not face unreasonable post-sale barriers to change product, switch provider, submit a claim or make a complaint)
• Where relevant, engaging with the Admed claims team and the respective medical schemes in respect of changing benefits and protocols, updating system rules and data file specifications
• Liaising with the contracted medical schemes in respect of all the claim's integration matters, including challenges, changes, etc
• Liaising with the Guardrisk IT Department and its appointed external developers in respect of system requirements, changes and problems
• Monitoring of claims-related system communication with customers, to ensure that customers are always kept up to date during the claims process

Competencies    

• Results and solutions driven
• Strong focus on client centricity and service excellence
• Strong problem solving and decision-making capability
• Organised and focused
• Analytical skills with attention to detail
• Resilience and ability to work under pressure
• Adaptability and self-discipline
• Effective communication skills and ability to professionally manager customers
• Disciplined and reliable
• A team player

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Role Purpose    

• To effectively and efficiently plan, organise, coordinate and control the reinsurance requirements for Guardrisk Life.

Requirements    

• Bachelor's degree in Actuarial Science, Mathematics, Statistics or related fields
• Good progress with the A100 and A200 series (CT series) exams
• At least 2 years’ life or non-life insurance working experience

Duties & Responsibilities    

• Structure optimal reinsurance arrangements for new and existing clients
• Negotiate competitive terms and timely renew existing reinsurance arrangements
• Review reinsurance contracts in accordance with the internal policies and procedures
• Oversee administrative implementation of reinsurance placements
• Engage clients and internal stakeholders on technical matters
• Review and implement optimal risk sharing strategy
• Provide strategic and operational support
• Establish networks and effectively communicate with a diverse range of stakeholders
• Annually review current reinsurance programs and structures and evaluate alternatives, and make recommendations
• Verify reinsurance accounts and liaises with stakeholders for remittance or reinsurance premiums in accordance with the contract requirements
• Cover operations in South Africa and Mauritius

Competencies    

• Planning and organising skills
• Networking skills
• Innovative
• Analytical thinking
• Interpersonal skills
• Excellent verbal and written communication
• Ability to work accurately under pressure and meet deadlines

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Role Purpose    

• To effectively and efficiently plan, organise, coordinate and control the reinsurance accounting requirements for Guardrisk Life.

Requirements    

• Degree or post graduate diploma in finance, accounting or relevant degree.
• At least 5 years’ experience in accounting or similar role.
• Planning skills
• Networking skills
• Innovative
• Analytical
• Interpersonal skills
• Excellent verbal and written communication
• Ability to work accurately under pressure and meet deadlines

Duties & Responsibilities    

• Management of the reinsurance accounting function for Guardrisk Life cell captive
• Assist in accounting for month end transactions for proportional and non-proportional reinsurance (recoveries and reinstatement premiums)
• Engaging with the general finance team on movements in the reinsurance financials
• Engaging with the portfolio managers on movements in the reinsurance financials
• Preparation, reconciliation and communication of proportional and non-proportional reinsurance accounts to the reinsurance market, clients and internally
• Comprehensive reinsurance claims management for proportional and non-proportional reinsurance
• Portfolio support and servicing by working closely with the portfolio manager and other stakeholders
• Identify and resolve problem sources or escalate to relevant level of authority
• Resolution of market enquiries on reinsurance matters
• Preparation and submission of renewal information on client portfolio
• Client reporting and engagement on reinsurance matters on a monthly basis for selected client portfolio
• Participate and contribute to a culture which build rewarding relationships, facilitates feedback and provides exceptional client service within the organisation
• Cover operations in South Africa and Mauritius

Competencies    

• Planning skills
• Networking skills
• Innovative
• Analytical
• Interpersonal skills
• Excellent verbal and written communication
• Ability to work accurately under pressure and meet deadlines