Responsibilities:

Coordinate and monitor all claim and related activities, which include the accurate checking and authorizing of all claims.
Ensure accurate process of approving and authorizing cycle of all claims, and monitoring and ensure all targets are met on all claims in the approval status.
Coordinate and monitor all responses to claim related enquiries including telephonic, email and visitor enquiries to avoid any financial risks and PI claims.
Ensure all claims in approval status are processed according to the rules, policies, legislation, administration procedures and the service level agreements applicable to the Fund.
Ensure thorough investigations are completed on all escalations and accurate responses are sent to members, employers, and service providers to limit financial and reputation risk to business by continuously improving on quality control measures.
Responsible for compiling data, preparing documents for audits, and responding to audit queries.
Assist with resolving audit findings and recommendations.
Assist with internal and external audits.
Assist in identify, develop, enhance, document, and make proposals to implement policies, procedures and processes that are relevant to the area of responsibility, including user acceptance testing of processes.
Compile accurate reports required by senior management in the required format.
Apply the rules, policies, and administration procedures of different funds in accordance with the agreed service levels.
Manage customer relations by communicating relevant and accurate information to customers resulting in customer satisfaction.
Monitor and analyze escalations and complaints, identify trends, and implement solutions and preventative measures.
Build and manage relationships with internal departments, external clients, and service providers.
Manage all exceptions to develop solutions which enable the payment, of claims.

Grow Relationships

responsible for servicing & retaining the major client assigned to them.
responsible for identifying enhancements & implementing where approved.
ensure all required information reaches clients & relationship is developed.
Build and maintain relationships with clients and internal and external stakeholders.

Effective - Solution Driven

Manage delivery and query resolution to avoid complaints/escalations.
Demonstrate commitment & determination to providing solutions to clients.
Will be required to perform other functions from time to time.

Efficient - Delivery Management

To be punctual, meetings with internal & external service providers to remain current.
Costs to be considered, demonstrating most effective methods for servicing client.
Ensure comprehensive and speedy resolution to client queries.
Deliver on service level agreement made with the clients and internal and external stakeholders to ensure that the client’s expectations are managed.
Effectively manage performance within the team to ensure business objectives are achieved.
Internal & External reporting to be submitted timeously - escalating where necessary, Professional communication, updating client, well presented & knowledgeable on Fund.
Identify gaps & map possible solutions for client and/or internal processes.
Team responsible for monthly merges and switches for entire business.
Accurate member build ups for the business.
Data management and reporting of discrepancies.
Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

General Management

Reporting client metrics (weekly/monthly/annually), translating metrics to business information, and overseeing the development of resulting action plans.
Collaborating with all implementing departments and provide oversight ensure that client requirements are understood and met.
Facilitating weekly project status update meetings and serve as an escalation point for any implementation issues.
Ensure accuracy of Data.
Distribute and execute all documents/stationery.
Develop exception and SLA reporting.
Benefit Statement Checking.
PFA Queries.
Staff KPA and ratings to submitted to reporting manager monthly.

Competencies required:

Excel
Communication (Written and Verbal)
English (Business writing and email etiquette)
Stakeholder management (CRM)
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

Qualifications:

Minimum of 5 years EB experience in a similar position
Strong knowledge of the Pension Funds Act
Financial Acumen
Advanced knowledge of Everest

Additional:

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 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.
Can communicate via different communication channels.
Effective management of resources to ensure delivery objectives of the business in line with SLAs and internal processes and procedures.
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 industry knowledge and experience.
Create a positive work climate and culture.
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.