Claims Administrator

2 weeks ago

Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Employee Benefits**Function**:Claims Administration**Date**:30 Jun 2023Achieve more than
- ***
**YOU BELIEVE**
- Discovery Employee Benefits- Claims Administrator**About Discovery**
- Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.**About Discovery Employee Benefits**
- Discovery Employee Benefits is the first and only employee benefits provider to be shaping employee behaviour, creating healthier and wealthier workforces. It is an exciting business to be in as we reimagine the way retirement savings and life insurance is brought to companies and employees.**Key Purpose**
- The position is responsible for the day-to-day administration and managing a small team within Group Life Operations. This is a core administration function and the incumbent would be required to holistically manage and control a portfolio of different Group Life disciplines, for example monthly contribution, claim, investment option, individual transfer in, section 14, section 28 processes. The incumbent must ensure that processes and procedures are implemented, maintained and improved. The incumbent needs to ensure operational activity is conducted within regulatory frameworks, accurately, effectively and efficiently. The incumbent must ensure that he/she has the knowledge, skills, tools and competencies required to perform the required job within service level agreements. The incumbent must have an appetite to be part of a growing new business unit, continuous improvement, able to adapt to change easily and play a role in change management within the team, challenge the status quo, inspire and motivate others. The incumbent will continually review existing processes and procedures in order to ensure the delivery of committed services to the Group Life Clients.**Areas of responsibility may include but not limited to**
- Receive claims from Indexing department for death and funeral claim assessments. Member, child or spouse claims as well as extended family members.
- Assess each claim by verifying claim details against standard claim requirements.
- High-light discrepancies picked up during the claim assessment, refer to Forensic Department. Ensure regular follow-ups with the Forensic department for investigation outcome.
- Liaise with the Administration department to confirm sum assureds, credit control and member covers.
- Process claim payments for death, funeral and disability claims.
- Handle claim related queries as well as assist with Call Centre overflow.
- Drafting of letters if required.
- Investigate and resolve actuarial queries.
- Register data checks.
- Investigate reason for query.
- Load QC to correct if require.
- Request for various data from the systems and business areas.
- Collate and compare data.
- Daily reporting.
- Daily comparisons between various system extracts (Cognos, register extract, paradigm extracts, payments etc.)
- Daily summary findings based on the comparisons.
- Resolutions to summary findings.
- Resolution of actuarial data queries within a short timeframe.
- Resolution of register data queries within a short timeframe.
- Follow up on outstanding data query resolution.
- Provide regular status updates.
- Daily register validation checks.
- Maintain, death, funeral and disability payment registers.
- Process Ad-hoc payments as and when required.
- Assist with investigating and resolving claim imbalances.
- Partake in adhoc projects/tasks assigned by Management.
- Receive claims for release and authorize claim payments within authorisation limits
- Personal Attributes
- Leading and Supervising
- Planning & Organizing skills
- Working with People - Communication
- Persuading and Influencing
- Adhering to Principles and Values - Self management
- Delivering Results and Meeting Customer Expectations
- Coping with Pressure and Setbacks
- Relating and Networking
- Teamwork and analytical skills
- Communication
- Problem solving
- Initiative and enterprise
- Learning
- Technology

**Education and Experience**
- Matric-essential and further studies are advantageous.
- Telephone etiquette, detail orientated and self-driven. Customer centric focus to be evident.
- MS Office
- Advanced Excel skills, Accounting, operational processes and process mapping. Employee Benefits including Group Risk claim operations.
- Knowledgeable on Compass; Paradigm (internal)
- 3 - 5 years claims experience in the long-term insurance industry. Pension and Provident Fund experience is advantageous

**Employment Equity**

The Company’s approve

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