Post-authorisation Advisor

**Who are we?**- ** What will you do?**- The Post-Authorization Advisor is a specialized role focused on the financial and technical governance of approved Short-Term Insurance claims. The primary objective is to ensure that costs associated with authorized claims are managed effectively, fairly, and accurately. This involves auditing service provider invoices (e.g., motor repairers, building contractors) and validating financial loss calculations for Business Interruption claims. The role serves as a crucial control point to prevent financial leakage and ensure the integrity of the claims process.

** What will make you successful in this role?**- ** Minimum Qualification Required**- Grade 12/Standard 10/NQF 4
- National Diploma (NQF 6) or bachelor’s degree in a relevant field (e.g., Finance, Risk Management, Law, Commerce)-
- **Minimum Experience**- Minimum of 3-5 years of experience within a claims environment in the Short-Term Insurance industry.
- Direct experience in claims assessing, loss adjusting, claims validation, or a dedicated cost-containment role is essential.
- Demonstrable experience negotiating with suppliers. Familiarity with industry quoting systems (e.g., Audatex for motor) and an understanding of building/repair costs. Experience reading financial statements is highly beneficial for BI.-
- **Deliverables**- Invoice and Quote Auditing: Scrutinize final invoices from service providers against authorized quotes, assessor reports, and company tariffs. For BI claims, audit financial statements and supporting documents to validate the quantum of the loss.-
- Cost Negotiation and Containment: Liaise and negotiate directly with service providers—including motor body repairers, building contractors, and specialist suppliers—to ensure costs are reasonable, customary, and aligned with agreed-upon rates.-
- Fraud, Waste, and Abuse (FWA) Detection: Identify and investigate potential instances of FWA by analyzing repair methodologies, supplier pricing, inflated labor hours, and suspicious patterns in BI calculations.-
- Provider Relationship Management: Build and maintain professional relationships with the approved service provider network to facilitate smooth communication, resolve disputes, and ensure compliance with company policies and Service Level Agreements (SLAs).-
- Scope Management: Monitor high-value or complex claims post-authorization to ensure the work completed does not extend beyond the original, authorized scope without proper justification and approval.-
- Reporting and Analysis: Generate regular reports on cost savings, provider performance, identified FWA trends, and negotiation outcomes to inform claims strategy.-
- **Competencies Required**- Analytical and Investigative Skills - Exceptional ability to analyze complex documents (quotes, invoices, financial statements), identify discrepancies, and investigate the root cause of inconsistencies.
- Negotiation and Influence - Strong negotiation and conflict resolution abilities, capable of achieving cost-effective outcomes while maintaining professional provider relationships.
- Meticulous Attention to Detail - Rigorous focus on accuracy when reviewing line items, part numbers, labor rates, and financial calculations to prevent overpayments.
- Technical and Financial Acumen - A strong understanding of the technical aspects of motor/property repair and the ability to interpret financial documents for BI claims.
- Assertive Communication - Clear, assertive, and professional communication skills (both written and verbal) to effectively query and challenge service providers on their costing and calculations.-
- **Knowledge and Skills**- Claims administration- Claims settlements- Payment approval and rejections- Operate within claims guidelines and compliance- ** Personal Attributes**- Self-development - Contributing independently- Decision quality - Contributing independently- Plans and aligns - Contributing independently- Manages conflict - Contributing independently- ** Build a successful career with us**- We’re all about building strong, lasting relationships with our employees. We know that you have hopes for your future - your career, your personal development and of achieving great things. We pride ourselves in helping our employees to realise their worth. Through its five business clusters - Sanlam Fintech, Sanlam Life and Savings, Sanlam Investment Group, Sanlam Allianz, Santam, as well as MiWay and the Group Office - the group provides many opportunities for growth and development.

** Core Competencies**- Cultivates innovation - Contributing independently- Customer focus - Contributing independently- Drives results - Contributing independently- Collaborates - Contributing independently- Being resilient - Contributing independently- ** Turnaround time**-
- **Our commitment to transformation**

At MiWay we believe in cultivating a positive and dynamic working environment that gives you freedom and opportunity to succeed. MiWay