A Long Term Insurance Company based in the East of Pretoria, needs to appoint a Junior Manager : Group Scheme Claims and Client Service Administration.

PURPOSE STATEMENT
Manage the claims section of the Group Schemes Administration

MAIN OUTPUTS AND RESPONSIBILITIES FOR THIS POSITION
1.Manage claims validation
•Oversee validation of death, disability and cash back bonus claims against master policy
•Provide advice on claims queries – irregularities, ex-gratia and action on fraud
2.Manage Claims Assessments
•Monitor approval of claims within 48 hours
•Investigate claims queries within 24 hours
3.Manage the Processing of Claims Pay-outs
•Approve confirmed pay-outs schedules
•Check and forward the transactions to Finance & IT to load on to banking system
•Report faulty systems to IT
•Liaise with Policy Administration department for client’s claims and refunds of premiums
•Conduct ITC checks
4.Manage monthly reconciliations
•Responsible and manage monthly reconciliation
•Manage reconciliation of payments with service provider, IT and Finance and update status report
•Send approved recon to Senior Manager for sign off
5.Produce reports on Claims Administration
•Provide monthly reports to GSA Management on Group schemes Claims Administration activities.
•Provide reports and stats to subsidiaries
6.Manage Client Services
•Monitor service delivery and turn-around times of group schemes claims queries (including Ombudsman, FSB, Legal entities)
•Manage and liaise with sales force and group scheme stakeholders to comply with group schemes rules
•Monitor and liaise with clients and escalated queries
•Keep abreast with changes and updates of the industry

Requirements
Degree in Business Administration
145 credits in Insurance as an advantage
5 years Life Insurance industry
3 years Management skills
2 years Group Schemes
2 years Claims Assessment
Product Knowledge Group Schemes and Funeral/Life Products (industry)
Group Schemes Administration and Claims processes
Legislation - ASISA, NCA, FSB, FSC, FAIS, FICA and BCEA
Basic Financial Management Premium Reconciliation