Claims Post-Authorisation Team Leader

Who are we?
At MiWay, our purpose is to enable people to live their way. We understand that life is not just about "things" but the meaning that those things bring to your life. We believe that technology and innovation have infinite possibilities when it's inspired by humans by you.

Therefore, we focus on our clients' needs; finding new ways to simplify their lives and how they do things.

We give them products, services, and solutions that enable them to live and enjoy life on their own terms – in their own way.

Agile values and principles are strongly embedded in our culture, and they are at the core of how we make decisions and how we approach adding value within the company.

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.

What will you do?
The Post-Authorization Team Leader role is responsible for overseeing and guiding a team focused on the financial and technical governance of approved Short-Term Insurance claims. The primary objective is to lead the team in ensuring that costs associated with authorized claims are managed effectively, fairly, and accurately, preventing financial leakage and upholding the integrity of the claims process.

This involves supervising the auditing of service provider invoices, validating financial loss calculations, and driving continuous improvement within the team. The role serves as a crucial control point, ensuring consistent application of company policies and strategies.

Minimum Requirements
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 5-7 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.

• Minimum of 3 years of demonstrable experience in a team leadership, supervisory, or senior specialist role, particularly in managing performance, coaching, and developing team members.

• Experience negotiating with suppliers. Deep familiarity with industry quoting systems (e.g., Audatex for motor) and a comprehensive understanding of building/repair costs. Proven experience reading and interpreting complex financial statements is critical for BI claims

Deliverables

• Team Leadership & Performance Management: Lead, mentor, and manage a team of Post-Authorisation Advisors. Set clear performance objectives, conduct regular performance reviews, provide constructive feedback, and facilitate professional development within the team.
• Invoice & Quote Auditing Oversight: Supervise the scrutiny of final invoices from service providers against authorized quotes, assessor reports, and company tariffs. Oversee the auditing of financial statements and supporting documents for BI claims to validate the quantum of the loss, ensuring accuracy and consistency across the team.
• Cost Negotiation & Containment Strategy: Develop and implement strategies for cost negotiation with service providers—including motor body repairers, building contractors, and specialist suppliers—to ensure costs are reasonable, customary, and aligned with agreed-upon rates. Provide guidance and support to the team in complex negotiations.
• Fraud, Waste, and Abuse (FWA) Detection & Prevention: Drive initiatives to identify and investigate potential instances of FWA by analyzing repair methodologies, supplier pricing, inflated labor hours, and suspicious patterns in BI calculations. Implement proactive measures and training to enhance the team's FWA detection capabilities.
• Provider Relationship Management & Escalation: Build and maintain strategic professional relationships with the approved service provider network. Act as an escalation point for complex disputes and ensure team compliance with company policies and Service Level Agreements (SLAs).
• Scope Management & Complex Claims Oversight: Monitor high-value or complex claims post-authorization, providing expert guidance to the team to ensure work completed does not extend beyond the original, authorized scope without proper justification and approval. Handle escalated scope creep issues.
• Reporting, Analysis & Strategic Insights: Generate regular, comprehensive reports on team performance, cost savings, provider performance, identified FWA trends, and negotiation outcomes. Provide strategic insights and recommendations to senior management to inform claims strategy and policy adjustments.
• Process Improvement & Optimization: Proactively identify opportunities to enhance existing post-authorization processes, implement best practices, and leverage technology to improve efficiency, accuracy, and overall team effectiveness

Competencies Required

• Exceptional Leadership & Coaching Skills: Proven ability to motivate, develop, and guide a team to achieve high performance. Strong capability in delegation, conflict resolution, and fostering a collaborative environment.
• Advanced Analytical & Investigative Skills: Superior ability to analyze complex documents (quotes, invoices, financial statements), identify discrepancies, investigate root causes of inconsistencies, and mentor others in these skills.
• Expert Negotiation & Influence: Advanced negotiation and conflict resolution abilities, capable of achieving optimal cost-effective outcomes while maintaining strategic professional provider relationships.
• Meticulous Attention to Detail: Rigorous focus on accuracy when reviewing line items, part numbers, labor rates, and financial calculations, ensuring team adherence to high standards to prevent overpayments.
• Strong Technical & Financial Acumen: A deep understanding of the technical aspects of motor/property repair and the ability to interpret complex financial documents for BI claims, with the capacity to train and guide others.
• Assertive & Strategic Communication: Clear, assertive, professional, and persuasive communication skills (both written and verbal) to effectively interact with and influence service providers, internal stakeholders, and senior management.
• Decision-Making & Problem-Solving: Robust ability to make sound decisions under pressure, solve complex problems, and provide strategic direction to the team

Knowledge And Skills
Drive leads and service targets

Coaching, quality and compliance

Reporting and communication

Management of employees

Personal Attributes
Decision quality - Contributing independently

Interpersonal savvy - Contributing independently

Plans and aligns - Contributing independently

Directs work - Contributing independently

Core Competencies
Cultivates innovation - Contributing independently

Customer focus - Contributing independently

Drives results - Contributing independently

Collaborates - Contributing independently

Being resilient - Contributing independently

Turnaround time
The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers.

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 is committed to transformation and embracing diversity. This is what drives us to achieve a multicultural workplace with employment equity as a key goal to create an inclusive workforce, reflective of the demographics of our society.