Head: Claim Operations
1 day 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 10-12 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 long-term planning, to create and manage budgets and to be a strategic thinker.
- Ability to achieve results by taking a proactive long-term view of business goals and objectives.
- Knowledge on continuous improvement/innovation and optimization methodologies.
- PFMA knowledge.
- Communication (Written and Verbal).
**Key performance Areas**
**Strategy development and operational planning**
- Lead the Implementation of the Claims Operations business strategy and plan that ensure alignment with short-term and long
- term objectives.
- 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 self-service 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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