Senior Manager: Claims (Claims Audit) - Centurion: 12 Months Contract

Affirmative Portfolios; Centurion; In loco; ZAR 1.234.000 - 1.508.000; Part-time

Descrizione del lavoro

Affirmative Portfolios in Centurion seeks a Senior Manager: Claims (Claims Audit) for a 12-month contract. The role oversees all claims operations, drives efficiency, and ensures payments are processed within regulatory timelines.

The ideal candidate has 9–10 years in claims operations, with at least 3 years in management, and a strong grasp of PFMA, claims systems, and motor vehicle accident legislation. This position offers a challenging, high-impact leadership role.

Competenze

• Bachelor’s Degree/Advanced Diploma in Business Management / Business Administration related qualification.
• Post graduate qualification in Business Management / Business Administration related qualification.
• 9-10 years of experience in Claims Operations with at least 3 years in management.
• PFMA knowledge and Motor Vehicle Accident legislation knowledge beneficial.

Mansioni

• Oversee Claims Operations to improve efficiencies and ensure processing of claims within target timelines.
• Develop and implement strategic plans for Claims Operations aligned with company objectives.
• Lead policy development and ensure compliance with legislative requirements and PFMA.
• Manage daily operations across processing and customer experience centers to ensure accurate assessment and adjudication of claims.
• Drive digitization initiatives within claims operations and deliver regular reporting to management.

Formazione

Bachelor’s Degree/Advanced Diploma in Business Management / Business Administration related qualification

Post graduate qualification in Business Management / Business Administration related qualification

Descrizione del lavoro

Senior Manager: Claims (Claims Audit) - Centurion: 12 Months Contract

Salary: R1,371,054 pa (Based on experience)

Purpose of the role:

The Senior Manager: Claims is accountable to oversee all the claims related operations to improve efficiencies and ensure that the company delivers on its mandate to process claims within 120 days for the compensation of claims for Road Accident victims.

Minimum Job Requirements and Experience:

Qualifications

• Bachelor’s Degree/Advanced Diploma in: Business Management / Business Administration related qualification.
• Post graduate qualification in: Business Management / Business Administration related qualification.

Experience

• Relevant 9-10 years’ experience in: Claims Operations environment of which 3 (three) years must have been on a management level.
• Advanced knowledge in: Claims management systems, insurance/reinsurance principles and Motor Vehicle Accident legislation will be advantageous.
• Knowledge of Motor Vehicle Accident legislation.
• PFMA knowledge.

Technical knowledge:

• Claims management process/ processes and systems (including handling, verification and validation, investigation, assessment/settlement, litigation, legal costs assessment and settlement).
• Post claim management and settlement.
• Medical bill reviewing.
• Medical case management.
• Complex problem identification, solving and decision making.
• Customer value proposition.
• Good financial management skills.
• Strong analytical capabilities.

Key Performance Areas

Strategy development and operational planning

• Provide input into the development of the Claims Operations business strategy and plan that ensure alignment with short-term and long-term objectives.
• Provide input into the development, implementation, and annual review of an overall Strategic Plan for the Claims Operations department.
• Provide input in determining and setting specific key performance indicators and measures against outcomes detailed in the departmental strategic plans.
• Oversee and guide the implementation of the Claims Operations plan as approved, including any appropriate special tasks or projects requested by management.

Policy review and Implementation

• Oversee the development and implementation of Claims policy, procedures, and processes.
• Work with appropriate structures to ensure effective execution of policies and practices.
• Provide advice and guidance to the Policy department on legislative compliance, emerging issues, risks and the implementation of changes required on policy matters.
• Proactively identify risks associated to the Claims function and develop and implement plans to mitigate risks and provide monitoring.

Claims processing management

• Oversee management of daily operations and functions for all claims processes within the company both in the processing centers and customer experience centers.
• Ensure that the claims received are assessed and aligned in accordance with merits thereof and adjudicated accordingly.
• Ensure the management of the full lifecycle of a claim process, including onboarding, validity and verification checks, merits assessments, adjudication, investigations, quantum assessment, offer management and post-crash settlement care.
• Ensure implementation of KPIs for products, including measurement frameworks and data feedback strategies.
• Ensure effective implementation of claims handling to manage loss cost and claim expenses.
• Ensure control procedures and initiatives to collect outstanding documentation and information pertaining to claims.

Overseeing implementation of digitization of claims operations

• Ensure all claims operation are implemented in line with the integrated claims management system.
• Ensure maintenance of appropriate systems for measuring necessary aspects of operations.
• Oversee the development and initiation of digital innovations within the claims process.

Reporting

• Ensure preparation and submission of Regulation reports.
• Report quarterly on progress with implementation of operational plans.
• Ensure development of functional reporting systems, project or performance reporting for management.
• Ensure the development of reports/ policies/ procedures and guide the process through the alignment of these documents to the overall company’s Strategy.
• Ensure that regular and periodic reports are prepared and submitted as and when required to provide progress updates and/or inform management decisions.

Stakeholder Management

• Maintain proactive and progressive relationships with key stakeholders.
• Engage with relevant internal stakeholders.
• Represent the Fund in relevant external activities and events.
• Communicate with all levels of stakeholder contact.
• Delegate inquiries and requests for information from both internal and external stakeholders.

Financial Management

• Ensure that the periodic financial and strategic goals of the company as well as the performance expectations of the various teams are achieved.
• Report and review operations financial and non-financial goals.
• Ensure sufficient internal control measures are implemented for adherence to PFMA, the company and other relevant legislation and regulation.
• Manage, monitor and control the department expense budget.

People Management

• Ensure sourcing, development and retention of a high-performing team.
• Ensure that recruitment of operational workforce is in line with employment equity targets.
• Ensure the motivation, cohesiveness, and alignment of the organization’s team members.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the company.
• Ensure Implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Manage and monitor performance of the team and implement corrective actions for poor performance.

NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.