Claims Approvals Specialist
2 months ago
About the Role:
We are seeking a highly skilled and experienced Claims Approvals Administrator to join our team at SALT Employee Benefits. As a key member of our claims team, you will be responsible for ensuring that all claims are processed efficiently and accurately, while maintaining the highest level of customer satisfaction.
Key Responsibilities:
- Coordinate and monitor all claim-related activities, including the complete claim processing cycle, claim-related enquiries or complaints, and Pension Fund Adjudicator and FSCA complaints/enquiries.
- Ensure all claims are quality assured and processed according to the rules, policies, legislation, administration procedures/processes, and service level agreements applicable to the Fund.
- Identify, develop, enhance, document, and make proposals to implement policies, procedures, and processes relevant to the claims team, including user acceptance testing of processes on Everest.
- Investigate, analyze, and monitor escalations and complaints. Report trends and obtain approval from the reporting manager for solutions to implement preventative measures.
- Support a positive and responsive climate for client enquiry resolution, respond to all complaints and enquiries (including PFA and FSCA), and submit responses to the complainant/Compliance Team within the service level agreement. Follow through and ensure feedback is provided until resolved.
- Ensure communication, whether internal or external, is dealt with professionally and within the service level agreement.
- Be responsible for assisting administrators with static data changes, rollbacks, delegations, and ad-hoc reports.
- Responsible for quality assessing (checking and releasing/audit confirm) of claims.
- Authorize payment of all claims (including funeral, death, and disability).
- Accept accountability and take responsibility for tasks done by reporting staff.
- Devote the whole of your time, attention, and abilities during working hours to the discharge of your duties with strict accuracy.
- Build and manage relationships with internal departments, external clients, and service providers.
- The duties include approving claims, managing, planning, monitoring, and reporting.
- Any other duties as determined by the business needs and to participate in all organizational events as required.
- The duties include approving claims, managing, planning, monitoring, and reporting.
- Ensure all claims are quality assured and processed according to the rules, policies, legislation, administration procedures, and the service level agreements applicable to the Fund to avoid financial risk and PI claims. No significant findings on internal audits 1% error rate, ensure that all claims are managed per legislative requirement.
- Ensure a thorough investigation has been completed on all escalations and enquiries and accurate responses are sent to members, employers, and service providers to limit financial risk to business by continuously improving on quality control measures.
- All escalations to be managed within 48 hours – where there is a dependency on other teams' members to be engaged within 48 hours of process to follow.
- Operational; Claims approver is responsible for the overall management of the allocated claims department team. The duties include managing, planning, monitoring, and reporting.
- Ensure that the claims team achieves the agreed targets weekly, which includes reducing the backlog by 10% per month and authorizing 30-60 claims per day for authorizers with no direct reports.
- All claims to be processed according to the rules, policies, legislation, administration procedures, and within service level.
- Manage performance of the team and ensure that all claims paid meet the quality requirements as agreed to and calculated accurately including monitoring and managing team's workflow reports. Accept Accountability and take responsibility of tasks done by team.
- Compile and provide accurate reports to the reporting Manager, in the required format by the agreed deadlines, to keep management and external stakeholders abreast of progress, delays, and or backlog. Compile and complete reports for the Manager.
- Customer: Manage customer relations for SALT Employee Benefits by communicating relevant and accurate information to customer resulting in customer satisfaction.
Relationship Management:
- Build and maintain relationships at all levels with reporting staff, all stakeholders, and internal departments to enhance organizational effectiveness and efficiency.
- Use your best endeavours to properly conduct, improve, extend, develop, promote, protect, and preserve the business interests, reputation, and goodwill of the company.
Reporting:
- Compile and provide accurate reports to the reporting manager, in the required format by the agreed deadlines, to keep management abreast of progress, delays, and or backlogs.
- Assisting and/or Responsible for any other reporting as per business requirements.
- Ensure a thorough investigation has been completed on all escalations and finalized within 24–48 hours, enquiries within 48–72 hours. Follow through and ensure client is provided with on-going feedback until resolved. Monitor escalations and complaints and provide managers with solutions to implement preventative measures.
- Develop claims team staff by mentoring, training, coaching, and developing personal growth as a leader within SALT EB.
Required Knowledge:
- Communication (Written and Verbal).
- Industry knowledge and experience.
- Accuracy and attention to detail.
- Judgement and Decision Making.
- Working under pressure and Deadline driven.
- Organizational skills/Planning and prioritizing.
- Interpersonal skills.
- Settings goals.
- Cross team collaboration.
- Management of time.
- People Management.
- Analysis of data.
- Judgement/Decision making.
- Negotiation and Conflict Management.
Qualifications:
- FICA awareness, POPI & TCF training.
- Diploma in Retirement Funds Management or Equivalent Qualification.
- 5–6 years' experience in the employee benefits/retirement fund industry.
- Extensive knowledge of the Pension Funds Act.
- Extensive knowledge of the Everest system.
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