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Head: Claim Operations
2 weeks ago
Business Management ~ Communication
Centurion
***:
Head:
Claim Operations - Centurion - Permanent-Salary: Market Related
Minimum Job Requirements
Qualification And Experience
- Bachelor's degree in business management / Business Administration / Medical / Health or related qualification.
- Post graduate qualification in Business Management / Business Administration or related qualification.
- At least 1012 years' relevant claims administration experience of which 5 (five) years must have been at a senior management level.
- Advanced knowledge in claims management systems, insurance/reinsurance principles and MVA legislation.
- Experience in the claims administration environment in the private and/or public sector.
Competencies
Managerial
- Change Management.
- Coaching and Mentoring.
- Conflict Management.
- Critical and Innovative Thinking.
- Direction Setting.
- Facilitating and Presentation Skills.
- People Management.
- Policy Conceptualisation and Formulation.
- Programme/Project Management.
- Risk Management.
- Service Delivery Innovation.
- Stakeholder Development and Relations.
- Reporting.
Behavioural:
- Strategic capability.
- Results Orientation
- Business and Financial Acumen
- Compliance and Governance
- Leadership Agility
- Resilience
- Communication
- Working with people
- Network and Alliances
- Planning, Organizing and Coordinating
- Employee Engagement
- Ethics and Values
- Client Service Orientation
Technical:
- Advanced knowledge of claims management systems.
- MVA legislation knowledge.
- Strong analytical, communication, leadership, managerial and organizational skills.
- Skilled in critical thinking, creativity in resolving unique and challenging business problems.
- Ability to do longterm planning, to create and manage budgets and to be a strategic thinker.
- Ability to achieve results by taking a proactive longterm view of business goals and objectives.
- Knowledge on continuous improvement/innovation and optimization methodologies.
- PFMA knowledge.
- Communication
Key performance Areas
Strategy development and operational planning
- Lead the Implementation of the Claims Operations business strategy and plan that ensure alignment with shortterm and long
- Lead the implementation and annual review of the overall Strategic Plan for the Claims Operations department.
- Oversee and implement specific key performance indicators and measures against outcomes detailed in the departmental strategic plans as set out by the Executive.
- Provide strategic input into the plan of the current and future interventions necessary to achieve acceptable levels and standards of the organization strategy and operational plans to the Executive forum.
Policy review and implementation
- Provide direction on the development and implementation of policy, procedures, and processes.
- Work with appropriate structures to ensure effective execution of policy 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.
Claims administration
- Provide strategic direction to ensure a complete and sound claim process (from initiation to close out phase), settlements, legal reviews, and investigations within 120 days target in accordance with the organization policies and procedures.
- Provide leadership in the interaction with customer experience function as the engine to maximising customer satisfaction within the claims process.
- Establish and maintain appropriate systems to perform claims processing, medical administration, and other claims related functions.
- Lead the development/design, implementation and maintenance of a selfservice portal that will enable a smooth claims process and foster transparency for the end user.
- Oversee and provide direction in the interaction with claims risk function to ensure that claims merits are thoroughly assessed, and determination is based on accurate information.
- Oversee and monitor the direct execution of claims operation policies to support overall company policies and objectives.
- Demonstrate successful execution of business strategies for the organization products and services.
- Liaise with other departments to identify improvements in claims process and procedure.
- Provide leadership and oversight in all the interactions with the actuarial function to ensure claims are successfully paid out correctly and in time.
- Oversee the implementation of a successful claims mediation process to minimize litigation of a claim as much as possible.
- Manage the interaction with the Legal function to provide effective litigation and other legal services where necessary.
- Ensure claims activities at a high level, comply with organisational requirements for quality management, legal stipulations, and general duty of care.
- Ensure claims are mea
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