Claims Specialist Midrand

BRIEF DESCRIPTION:-

The Claims Specialist for Section 37C, Disability & Funeral benefits manages the TSRF administration team, oversees claim-related activities, develops relevant policies, and ensures claims are processed according to rules and regulations. Essential qualifications include a matric with maths, FICA awareness, and 5-6 years of experience in the employee benefits industry, particularly with Section 37C of the Pension Funds Act.

Job Title: Claims Specialist Company: Salt Employee Benefits

Salary: Market Related

Reference: 208317

Role Overview

The Claims Specialist for Section 37C, Disability & Funeral benefits is tasked with comprehensive management of the team. This role encompasses duties such as managing, planning, monitoring, and reporting. The specialist will oversee the TSRF administration team in the absence of the senior manager, presenting Board reports to the TSRF Board of Management and Sub-committees when necessary.

Key Responsibilities

• Assist other Specialists/Team Leaders with TSRF team operations in the absence of the senior manager. - Coordinate and oversee all claim-related activities, including the full claim processing cycle, all claim-related inquiries or complaints, including Pension Fund Adjudicator and FSCA complaints/enquiries. - Ensure all claims are processed according to the rules, policies, legislation, and service level agreements applicable to the Fund. - Develop, enhance, document, and propose policies, procedures, and processes relevant to the claims team, including user acceptance testing on Everest. - Investigate, analyze, and monitor escalations and complaints; report trends and obtain approval for implementing preventative measures. - Foster a positive and responsive climate for client enquiry resolution, responding to all complaints and enquiries (including PFA and FSCA) and providing feedback until resolved. - Ensure professional communication, both internal and external, is handled within the service level agreement. - Compile data, prepare documents for audits, and respond to audit queries. - Select, appoint, and assign team members, provide input on job descriptions, and train, mentor, and coach team members. - Set performance areas with staff and manage employee performance to meet production standards in terms of quantity and quality. - Delegate work to team members, coordinate team leave, and report any irregularities to the reporting manager. - Quality assess claims, authorize payments (including funeral, death, and disability), and take accountability for tasks done by reporting staff. - Devote full time, attention, and abilities during working hours to the discharge of duties with strict accuracy. - Participate in all organizational events as required.

Relationship Management

• Build and maintain relationships at all levels with reporting staff, stakeholders, and internal departments to enhance organizational effectiveness and efficiency. - Conduct business in a manner that protects and promotes the company’s reputation and goodwill. - Compile and provide accurate reports to the reporting manager, in the required format by the agreed deadlines, to keep management informed of progress, delays, and backlogs. - Assist in drafting and completing Risk and Admin Sub-committee reports. - Assist in preparing quarterly reports to actuaries of the Fund. - Assist in providing monthly reports to the Insurer of the funeral scheme.

Qualifications

• Matric with maths - FICA awareness, POPI & TCF training - Good command of English, both verbal and written

Essential Skills & Experience

• 5 - 6 years’ experience in the employee benefits / retirement fund industry, with at least 3 - 4 years in a leadership role (if external) - Extensive knowledge of Section 37C of the Pension Funds Act - Ability to interpret documents submitted for death claims; make an appropriate evaluation and final recommendation including the allocation of benefits to the Board of Management - Good interpersonal skills - Planning/Organising: prioritize, work efficiently and productively, and manage time well - Problem Solving: ability to take a logical and analytical approach to solving problems and resolving issues - Adaptability/Flexibility: ability to manage reporting staff and multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments - Good verbal and written communication skills - Reliability - Responsibility - Ability to work under pressure - Good knowledge of Microsoft Outlook, Word, Excel, and PowerPoint - Extensive knowledge of the Everest system