Role Overview:
As the Specialist: Claims Approval he/she must have the ability to check and apply expertise to data with an intended objective to deliver on the specific area of expertise. Furthermore, we could 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. Should be able to engage and list to current challenges in the team/business and use expertise to Trouble shoot issues in order to provide workable solutions. They must have the ability to tackle a Problem with the intent of using expertise/capability and or experience to resolve speedily. Investigate and manage improper payments and PFA related issues.

Key Activities

• Coordinate and monitor the complete claims processing cycle, ensuring that all claims, inquiries, and complaints (including those from the Pension Fund Adjudicator and FSCA) are handled in accordance with policies and SLAs.
• Ensure all claims are quality-assured and processed according to the relevant policies, legislation, and procedures.
• Policy & Procedure Development: Identify, enhance, and document proposals for policies and processes that improve the claim’s function.
• Engage in user acceptance testing of processes on Everest.
• Investigate and analyse escalated complaints or issues, report trends, and propose solutions to the reporting manager for approval and implementation.
• Assist administrators with data changes, rollbacks, delegations, and ad-hoc reporting as required.
• Tracking and managing inflow and outflow of work output in the team.
• Responsible for quality assessing (checking and releasing/ audit confirm) of withdrawal claims, death, and disability, that are processed correctly.
• Ensure tasks are completed with strict accuracy and within deadlines, focusing on high standards of work quality.
• Ensure that all daily, weekly and monthly stats reports are completed timeously.
• Flag and escalate work that is has been started and not finalised to the manager.
• Ensure tracking and output of action items emanating from the trustee meetings.
• Implement, track and manage all controls in the team (movement of switches/merges etc.).
• Responsible for compiling data, preparing documents for audits and responding to audit queries.
• Identify, develop, enhance document and make proposals to implement policies, procedures and processes that are relevant to the Exits team.
• Investigate, analyse and monitor stops in the team.
• Report trends and obtain approval from the reporting manager for solutions to implement preventative measures.
• Ensure queries whether internal or external is dealt with professionally and within service level agreement.
• Accept accountability and take responsibility of all tasks assigned.
• Devote the whole of your time, attention and abilities during working hours to the discharge of your duties with strict accuracy.
• Participate in any additional duties as determined by the business needs and organizational events.
• Identify opportunities for improving claims processes and contribute innovative solutions to increase efficiency and accuracy.
• Uphold the company’s values and image in all interactions, ensuring professional conduct in both internal and external communications.

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.
• Report any irregularities to the reporting manager.

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.
  
• Maintain professional communication with clients, stakeholders, and internal teams, ensuring satisfaction and effective resolution of claims-related issues.
  
• Ensure that reports required by the trustees and business is managed timeously.

People Management

• Implement the culture transformation programme that will enable the delivery of Salt’s strategic intent and identify ideal behaviours to improve employee engagement and reduce employee turnover.
  
• Develop a high performing team by embedding formal performance development and informal coaching. Implement talent acquisition, engagement and recognition process in line with this.

KPI’s

• 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.
• Investigate and report findings on improper payments.
• 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 team members to be engaged within 48 hours of process to follow.
• 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.
• Set and agree meaningful and interactive performance areas with staff.
• Client satisfaction ratings related to claim processing and communication.
• Respond to all client complaints, inquiries, and escalations (including from the PFA and FSCA) within the service level agreement, ensuring timely and professional communication.

Required Qualifications & Experience

• Matric
• Excel
• FICA awareness, POPI & TCF training
• Communication (Written and Verbal)
• Stakeholder management (CRM)
• Industry knowledge and experience
• Accuracy and attention to detail
• Judgement and Decision Making
• Working under pressure And Deadline driven
• Interpersonal skills
• Investigative and risk management skills
• Cross team collaboration
• Management of time
• People Management
• Analysis of data
• Negotiation and Conflict Management