Team Leader: Claims

PURPOSE OF THE ROLE

The Claims Team Leader is responsible for the overall management of the claims team. The duties include, managing, planning, monitoring and reporting. The Claims Team Leader reports to the Manager: PSSPF Claims.

• The ability to investigate and apply expertise to data with an intended objective to deliver on the specific area of expertise.
• The ability to analyze data and extract trends to ensure improvement of processes and or customer satisfaction. This could be in the form of innovative ideas as well as the task of compiling reports.
• Engage and list to current challenges in the team/business and use expertise to Trouble shoot issues in order to provide workable solutions
• The ability to tackle a Problem with the intent of using expertise/capability and or experience to resolve speedily
• Perform quality assurance based on the specialized requirements of the role.
• Should be able to ensure strong stake holder management ito Communication i.e. feedback to clients, managing clients, responding to clients, attend to queries timeously
• Engage in a professional manner whether it be verbal or face to face
• Have the ability to communicate via different communication channels
• Ensure that the brand or image of SEB is always maintained by adhering to the values (in keeping in line with the KPI and values of the company)
• Be a strong team player
• Have both both industry knowledge and experience
• Ensure that the role is carried out with the relevant accuracy, attention to detail and following instructions.
• Ensure that judgement and attention to detail is applied to the role
• Ensure that the role is completed within required deadlines and should have the ability to organize, plan, set goals and deliver accordingly.
• Strong interpersonal skills as cross team collaboration is required.
• Have the ability to innovate in the role
• Quality of work should be thorough
• Conscious of the abuse of company resources
• The Section 37C, Disability & Funeral benefits Claims Team Leader is responsible for the overall management of the team. The duties include, managing, planning, monitoring and reporting. The Team Leader is responsible for managing operations of the team in the absence of the manager, including presentation of Board reports to the Board of Management and Sub-committees in the absence of both the manager and CRM.

SPECIALIST REQUIREMENTS

• Ensure that all quality assurance related activities as set out in the Quality Assurance checklist have been actioned.
• Ensure completion of the quality assurance process as set in the Quality assurance checklist
• Contact member for outstanding requirements and update notes on the system
• Calculate the benefit
• Apply for a tax directive
• Prepare the payment requisition
• Ensure the bank details have been accurately captured onto the members record and verified by the bank
• Ensure all relevant documentation are saved onto member’s record.
• Ensure all relevant checks are done on the system before processing a claim
• Meet production standards in terms of quantity (100 assessment daily including payments of 25-30 claims to tax daily
• Should a query raise at any point, complete the investigation and delegate to responsible party to resolve
• Ensure compliance to all control in the teams (switches, merges etc.)
• Devote your whole time and attention and abilities during working hours to the discharge of your duties with strict accuracy
• Ensure all email communication , whether internal or external are dealt with professionally within service level agreement
• Ensure all documentation relating to a claim are saved in the member profile on the system
• Ensure appropriate notes are recorded in the member profile on the system

PEOPLE MANAGEMENT 

Implement the culture transformation programme that will enable the delivery of Salt’s strategic intent and identified ideal behaviours to improve employee engagement and reduce employee turnover.

AREAS OF RESPONSIBILITIES/ KEY ACTIVITIES

• Assisting alongside other Team Leaders with operations of the team in the absence of the manager.
• Coordinate and monitor all claim related activities, which include the complete claim processing cycle of all claims, all claim related enquiries or complaints including 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 the service level agreements applicable to the Fund.
• Identify, develop, enhance, document and make proposals to implement policies, procedures and processes that are relevant to the claims team, including user acceptance testing of processes on Everest.
• Investigate, analyses and monitor escalations and complaints. Report trends and obtain approval from 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 response 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.
• Responsible for compiling data, preparing documents for audits and responding to audit queries.
• Assist in selecting, appointing and assigning team members.
• 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.
• Any other duties as determined by the business needs and to participate in all organizational events as required.

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 endeavors 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 drafting and completion of Risk and Admin Sub-committee reports.
• Assisting and or Responsible for quarterly reports to actuaries of the Fund.
• Assisting and or Responsible for provision of monthly reports to the Insurer of the funeral scheme.
• Assisting and or Responsible for any other reporting as per business requirements.

KPI :

• 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; The Team Leader is responsible for the overall management of the allocated claims department team. The duties include, managing, planning, monitoring and reporting
• direct reports
• All claims to be processed according to the rules, policies, legislation, administration procedures and within service level. Manage QA sampling of claims and ensure that feedback is given to staff, Provide a report on all QA assessment done against calls made to clients to ensure members are contacted and also given the correct feedback
• Team leader must ensure that all individual team consistently reaches target for productivity
• In terms of auths team leader must ensure that daily target of 40 claims assessed is met
• 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
• Team leader must ensure that all individual team consistently reaches target for productivity
• 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 backlogs Compile and complete reports for Manager
• Identify, develop, enhance and implement policies, processes and procedures that are relevant to the claims team. Take responsibility for your team’s EBSphere issue logs, including testing.
• Customer :Manage customer relations for SALT Employee Benefits by communicating relevant and accurate information to customer resulting in customer satisfaction
• 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 manager with solutions to implement preventative measures, Build and manage relationships with internal departments, external clients and service providers including the front offices, walk-in centers etc.
• Consistently ensures team reaches assigned target
• Ensure that all system communications are adhered to e.g. ensure team captures notes on Everest system in terms of status of the claims thus the call center / Front office to see communication
• People, learning & development
• Develop claims team staff by mentoring, training, coaching and developing personal growth as a leader within SALT EB
• Set and agree meaningful and interactive performance areas with staff. Manage employee performance (KPI), team cohesion and service excellence within the team
• Train, mentor and coach staff (complete training log) 

QUALIFICATIONS

• FICA awareness, POPI & TCF training.
• 5 - 6 years’ experience in the employee benefits / retirement fund industry of which at least 3 - 4 years practical experience in a leadership role (if external).
• Extensive knowledge of Section 37C of the Pension Funds Act.
• Extensive knowledge of the Everest system.

COMPETENCIES REQUIRED

• 5 - 6 years’ experience in the employee benefits / retirement fund industry of which at least 2 years practical experience in a leadership role (if external).
• Matric
• Excel
• Communication (Written and Verbal)
• English (Business writing and email etiquette)
• Stakeholder management (CRM)
• 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
• Innovation
• Management of time
• People Management
• Analysis of data
• Judgement/Decision making
• Innovation
• Negotiation and Conflict Management