Team Manager Claims Assessment

2 weeks ago

Johannesburg, Gauteng, South Africa PPS Recruitment Full time

Job Advert Summary:

A leadership role in the Life Operations team reporting to the Claims Manager.

This role is responsible for managing a team responsible for assessing Sickness, Permanent Incapacity and Disability Claims as well as Case/Claims Management of ongoing claims.

Ensure best practice and supporting the company in meeting its objectives.

Minimum Requirements:

Education:

  • Degree in Occupational Therapy or Physiotherapy or any other medical/health quality.
  • Management qualification would be advantageous.

Experience:

  • 10+ years' experience within the claims environment, of which 3 years as a team leader or team manager.
  • 5+ years' experience in sickness and permanent disability claims assessment at a senior level.
  • Case Management experience is an advantage.

Knowledge and Skills:

  • Claims management principles.
  • Audit principles.
  • Risk management.
  • Long Term Insurance legislations background.

Competencies:

  • Problem solving.
  • Business Acumen
  • Writing and communication skills including the ability to communicate technical information.
  • The ability to prioritize and multitask.
  • Teamwork, leadership and motivational skills
  • Proactive thinking.
  • People skills and able to communicate at all levels.
  • Able to handle pressure situations

Duties and Responsibilities:

Role and Responsibilities:

  • Lead a team responsible for longterm sickness claims, Permanent Incapacity and Disability claims
  • Authorize claims within the approved Delegation of Authority.
  • Respond promptly to all queries/escalations raised by members, PPS Branches, Internal Advisors/Brokers and other stakeholders.
  • Align and maintaining process to ensure effective claims assessment and decisions are taken.
  • Liaise with internal stakeholders to ensure finalization.
  • Attend to complaints received through written or telephonic communication.
  • Drive risk awareness and controls within the claims team and report any operational loses.
  • Ensure that TCF (Treating Customers Fairly) principles are embedded in the claims assessment process.
  • Manage claims assessment output.
  • Contribute to the improvement of claims process and member experience.

People Leadership and Culture:

  • Provide team leadership ensuring the effective implementation of strategy through leadership of the team members (setting individual objectives, managing performance, developing and motivating staff, provision of formal and informal feedback and appraisal) in order to ensure that the highest level of performance is achieved.
  • Mentor team members as needed or required; conducts peer review of key deliverables.
  • Creates an environment where people are encouraged to take ownership and use their initiative to find the best way of implementing plans.
  • Provide support to claims assessors ensuring clear, concise and transparent communication.
  • Work nonstandard business hours from time to time.

Risk and Compliance:

  • Adhere to internal SLA's to ensure operational efficiency and achievement of agreed customer service standards.
  • Compiling monthly Case Management, Permanent Incapacity and Disability reports to expose operational opportunities and risk management in claims.
  • Identify trends in claims and train consequences thereof into the claims team and long term management of claims.
  • Ensure adherence to audit requirements.
  • Ensure adherence to regulatory and compliance requirements

People and Culture:

  • Collaboration with Research and Development, Actuarial, Operational Finance, Underwriting, Reinsurers and other relevant role players to effectively manage claims.
  • Collaborate with Research & Developments to ensure continuous improvement and updating of work instructions and process documents.
  • Provide input in development and updating guidelines to support the assessment of claims.

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