Claims Processing Manager

3 weeks ago


Johannesburg, South Africa Adzuna ZA B C2 Full time
Manage internal departmental functions and processes
  • Develop and implement plans for the section that support Pension Administration and the company's objectives, ensuring optimisation of current business and workflow processes.
  • All benefit processing activities in accordance with the benefits as defined in the rules of the Fund and applicable legislation.
o Unclaimed benefits and Evidence of Survival reviews, tracing and verification
o Fund valuation and all audits
  • Provide interpretation advice on the application of the Rules of Fund.
  • Ensure that audit controls are in place and audit requests are followed up.
  • Participate on the defined Committees (Benefits Committee (BC), Medical Panel (MP), Management Benefits Committee (MBC)) and take decisions based on formal documentation.
Project Management
  • Participate in the Funds overall projects as required with continuous focus on Business Processes, system enhancements, omni channel business insight, contributing expertise to enable project objectives to be met.
  • Draft reports as part of the project deliverables.
Provide input to the strategic management of the section
  • Contribute ideas for improved service delivery at Management meetings.
  • Compile comprehensive business reports for this function, highlighting successes and risks in terms of achieving the sections objectives.
  • Keep abreast with changes in relevant guidelines and other legislation, to make recommendations where policies and procedures need to be amended.
Oversee Section 37C dependency investigations on death benefits allocations
  • Manage investigations on death benefit cases confirming dependency with recommended benefits allocation percentages for approval by Benefits Committee.
  • Monitor that outstanding banking details for payment of approved death benefits are followed up, and confirmed.
  • Verify that death benefits allocation reports produced are legally compliant with recommendations and reflect minimal errors.
Oversee the provision of social services to guardian cases; implementation of Benefits Committee & Medical Panel decisions and requests / referrals for case investigations and social advice from other internal departments
  • Implementation of decisions, requests and referred cases, with reports and recommendations being submitted to BC, MP& BP or other internal departments.
  • Ensure compliance with Fund rules and legislation to suspension, addition, termination and reinstatement of beneficiaries (widows and minor children) in compliance.
Financial Management
  • Forecast annual capital and operational expenses for the section in line with corporate policy.
  • Manage costs against approved budget.
  • Investigate methods to contain / reduce costs.
Corporate Governance
  • Ensure compliance to procedures and relevant legislation
  • Provide detailed, accurate information for internal and external audit purposes within specified deadlines.
  • Action audit issues identified within time frames indicated.
  • Implement controls within the section which minimize potential risk to stakeholders.
REQUIRED MINIMUM WORK EXPERIENCE AND QUALIFICATIONS
  • Relevant Bachelors Degree, preferably in Law. Registered with professional bodies - where applicable
  • At least 6 years job-related experience, which should include at least 2 years experience in a management role
  • Knowledge of an African Language is an advantage
  • Working knowledge of Pension Fund Rules
  • Basic knowledge of Income Tax Act, Divorce Act, Pension Funds Act, Child Care Act, Marriage Act, Recognition of Customary Marriage Act, Mental Health Act
  • Working knowledge of Benefit administration
  • Knowledge of Law - Section 37 (C) allocation of death benefit lump sums
  • Valid drivers license

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