Talent Pool: Claims Team Leader MMH251128-19

Momentum; Sandton; On-site; ZAR 700,000 - 900,000; Full time

Job summary

Momentum in Sandton is seeking an experienced claims leader to drive team performance, resolve client queries and process claims in line with business expectations and client experience goals.

You will manage a claims team, monitor SLA delivery and mentor staff, while collaborating with internal stakeholders to improve processes and overall client satisfaction.

Qualifications

• Matric is a minimum requirement.
• 4-6 years' Claims experience in the Medical Aid industry is essential.
• 1-2 years' people management experience is essential.

Responsibilities

• Manage, monitor and control the Claims team’s delivery on service level agreements with clients.
• Manage, monitor and control the team’s execution of client claims and queries.
• Act as an escalation point to assist Claims team addressing client queries.
• Ensure team adherence to correct procedures when following up on queries.
• Analyse Claims Administration processes and identify opportunities for improvements; implement improvements within the Claims team.
• Identify and report process and system failures to improve client experience.

Skills

Claims experience

People management

Education

Matric

Job description

Role Purpose

To lead and manage the claims team to resolve client queries and process claims aligned to business expectations and aligned to desired client experience

Requirements

• Matric as a minimum
• 4 - 6 years' Claims experience in the Medical Aid industry is essential
• 1 - 2 years' people management experience is essential

Duties and Responsibilities

Internal Process

• Manage, monitor and control the Claims team’s delivery on Service Level Agreements made with clients.
• Manage, monitor and control the team’s execution of client claims and queries.
• Act as an escalation point to assist Claims team addressing client queries.
• Ensure team’s adherence to correct procedure when following up on queries.
• Analyse the Claims Administration processes and identify opportunities for improvements; implement improvements within the Claims team.
• Identify and report process and system failures and enhancements to improve client experience.
• Investigate client queries within the agreed service level and ensure that client receives timeous feedback.
• Escalate client queries to the relevant department or stakeholder

Client Service

• Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate after sales services.
• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets.
• Provide authoritative, expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

People

• Develop and maintain productive and collaborative working relationships with peers and stakeholders
• Positively influence and participate in change initiatives
• Continuously develop own expertise in terms of professional, industry and legislation knowledge
• Contribute to continuous innovation through the development, sharing and implementation of new ideas
• Take ownership for driving career development

Finance

• Contribute to the financial planning process within area
• Identify opportunities to enhance cost effectiveness and increase operational efficiencyManage financial and other company resources under your control with due respect
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum

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