Claims Specialist

Salt Employee Benefits; Gauteng; On-site; ZAR 850,000 - 1,200,000; Full time

Job summary

Salt Employee Benefits is seeking a Section 37C, Disability & Funeral Benefits Claims Specialist to lead the TSRF administration team in Gauteng. You will manage operations, planning, monitoring and reporting, including presenting Board reports in the absence of the senior manager.

You will oversee claim processing, handle escalations, ensure compliance with policies and SLAs, and develop process improvements.

Qualifications

• 5-6 years’ experience in employee benefits/retirement fund industry.
• At least 3-4 years in a leadership role (external).
• Extensive knowledge of Section 37C of the Pension Funds Act.

Responsibilities

• Lead and manage the TSRF administration team to ensure effective operations.
• Coordinate and monitor all claim activities, including processing and enquiries.
• Ensure claims are quality checked and processed per policies and SLAs.
• Develop, document and propose policy improvements; perform user acceptance testing in Everest.
• Report trends, escalate issues, and implement preventative solutions.
• Prepare board reports and maintain professional communications with stakeholders.

Skills

Leadership

Planning/Organising

Problem Solving

Communication

MS Office

Everest System

Education

Matric with maths

FICA awareness, POPI & TCF training

English proficiency

Tools

Everest system

Microsoft Office (Outlook, Word, Excel, PowerPoint)

Job description

Role Overview:

The Section 37C, Disability & Funeral benefits Claims Specialist is responsible for the overall management of the team. The duties include, managing, planning, monitoring and reporting. The Team Leader is responsible for managing operations of the TSRF administration team in the absence of the senior manager, including presentation of Board reports to the TSRF Board of Management and Sub-committees in the absence of both the senior manager and CRM.

Key Responsibilities:

• Assisting alongside other Specialists / Team Leaders with operations of the TSRF team in the absence of the senior manager.
• Coordinate and monitor all claim related activities, which include the complete claim processing cycle of all claims, all claim related enquiries or complaints including Pension Fund Adjudicator and FSCA complaints / enquiries.
• Ensure all claims are quality assured and processed according to the rules, policies, legislation, administration procedures / processes and the service level agreements applicable to the Fund.
• Identify, develop, enhance, document and make proposals to implement policies, procedures and processes that are relevant to the claims team, including user acceptance testing of processes on Everest.
• Investigate, analyse and monitor escalations and complaints. Report trends and obtain approval from reporting manager for solutions to implement preventative measures.
• Support a positive and responsive climate for client enquiry resolution, respond to all complaints and enquiries (including PFA and FSCA), and submit response to the complainant / Compliance Team within the service level agreement. Follow through and ensure feedback is provided until resolved.
• Ensure communication, whether internal or external is dealt with professionally and within the service level agreement.
• Responsible for compiling data, preparing documents for audits and responding to audit queries.
• Assist in selecting, appointing and assigning team members.
• Provide input to job descriptions for team members within the claims team.
• Train, mentor and coach team members.
• Set and agree performance areas with staff and manage employee performance to ensure production standards are met in terms of quantity and quality.
• Delegate work to team members.
• Co-ordinate team's leave.
• Report any irregularities to the reporting manager.
• Responsible for quality assessing (checking and releasing / audit confirm) of claims.
• Authorise payment of all claims (including funeral, death and disability).
• Accept accountability and take responsibility for tasks done by reporting staff.
• Devote the whole of your time, attention and abilities during working hours to the discharge of your duties with strict accuracy.
• Any other duties as determined by the business needs and to participate in all organisational events as required.
  

Relationship Management:

• Build and maintain relationships at all levels with reporting staff, all stakeholders and internal departments to enhance organisational effectiveness and efficiency.
• Use your best endeavours to properly conduct, improve, extend, develop, promote, protect and preserve the business interests, reputation and goodwill of the company.

Reporting:

• Compile and provide accurate reports to the reporting manager, in the required format by the agreed deadlines, to keep management abreast of progress, delays and or backlogs.
• Assisting and or Responsible for drafting and completion of Risk and Admin Sub-committee reports.
• Assisting and or Responsible for quarterly reports to actuaries of the Fund.
• Assisting and or Responsible for provision of monthly reports to the Insurer of the funeral scheme.

Qualification:

• Matric with maths.
• FICA awareness, POPI & TCF training.
• Good command of English both verbal and written.

Essential Skills & Experience:

• 5 - 6 years’ experience in the employee benefits / retirement fund industry of which at least 3 - 4 years practical experience in a leadership role (if external).
• Extensive knowledge of Section 37C of the Pension Funds Act.
• Ability to interpret documents submitted for death claims; make an appropriate evaluation and final recommendation including the allocation of benefits to the Board of Management.
• Good interpersonal skills.
• Planning / Organising: prioritise, work efficiently and productively and manage your time well.
• Problem Solving: ability to take a logical and analytical approach to solving problems and resolving issues.
• Adaptability/Flexibility: ability to manage reporting staff and multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments.
• Good verbal and written communication skills.
• Reliability.
• Responsibility.
• Ability to work under pressure.
• Good knowledge of Microsoft Outlook, Word, Excel and Power point.
• Extensive knowledge of the Everest system.