Claims Specialist

2 weeks ago

Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Employee Benefits**Function**:Claims Administration**Date**:25 Jan 2024Achieve more than
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**YOU BELIEVE**
- Discovery Employee Benefits- Claims Specialist_

**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 of the role**
- The primary function of this role is comprised of two aspects, the first is to identify, assess and manage claims payments with internal and external stakeholders within the Annuity Management process. The second is to take on key reporting, people leadership and project leadership tasks within the Disability Claims Team. A key purpose is to add value to current processes by identifying gaps, developing processes and proposing innovative recommendations that will impact efficiencies and the quality of work produced. You will therefore need advanced technical skills, particularly in excel, excellent communication skills, sound financial knowledge, and be comfortable working to extremely tight deadlines. The ultimate goal of the role is to manage the disability claims payments experience through innovative and efficient claim management as well as develop quality management outputs and functional leadership skills providing key support to the management of the team as a whole.
- **Areas of responsibility may include but not limited to**:

- Ensure the effective validation and assessment of all annuity disability claims according to company policy whilst having a client centred approach ingrained into the communication and management of all relevant stakeholders and clients
- Second assessment, second approval and authorisation of annuity claims within agreed authority structures and targets in accordance to client service levels, claims management and process requirements.
- Communicate to internal and external stakeholders on set requirements and progress on annuity claims in payment assessment, in a clear, friendly and concise manner using appropriate language and a client centric approach.
- Ensure all Internal and External communication (Written and Verbal) is done in a professional manner and in line with the company policy and does not contravene the POPI Act.
- Ensure that all queries are answered correctly in a logical and fair manner in accordance client service levels using a client centric approach
- Bring financial expertise, experience and skills and assist with continual training, coaching, mentoring, development, empowerment and performance of fellow annuity claims team members.
- To liaise with associated persons such as Reinsurers, Legal Officers, actuarial investigations and management
- Work effectively in a team environment, share information and provide support to other team members
- Contribute to team and cross-team processes, discussions, interactions, activities and programmes
- Create and Implement initiatives and opportunities for change and improvement - within the team, business and self.
- Maintains and develops professional relationships with internal and external clients and ensure the best communication with customers using a client centric approach.
- Seeks and receives the advice and input of others
- Participate in personal and professional development activities, training, and courses
- Additional ad hoc preparations for Audits (Internal and External), Compliance audits and TCF
- Development of an internal Quality Control Process
- Implement monthly internal QA Audits for the Annuity assessors (Quality of the assessment and benefit calculations)
- Monthly trending of the IQS breach (What is the Root cause) - Training purposes and to implement quality control process for corrective action and preventative measures.
- Monthly trending of Escalation and Complaints (What is the Root Cause)
- Monthly trending of Root Cause Analysis.
- Identifying the gaps from the RCAs and reporting on this to management on a monthly basis( RCA course)
- Identifying training needs and opportunities for the Assessors
- Identifying the gaps with SPS and reporting on this to management on a monthly basis
- SOP management for the Assessors
- New staff training and co-sign off with Annuity Manager
- Assist with Audit preparation

**P

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