Team Leader : Claims (Death)

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.

Key Responsibilities

• 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, including compiling reports.
• Engage and listen to current challenges in the team/business and use expertise to troubleshoot 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.
• Ensure strong stakeholder management in communication, including feedback to clients, managing clients, responding to clients, and attending to queries timeously.
• Engage in a professional manner, whether verbal or face-to-face.
• Have the ability to communicate via different communication channels.
• Ensure that the brand or image of SEB is maintained by adhering to the values in line with the KPI and values of the company.
• Be a strong team player.
• Have both industry knowledge and experience.
• Ensure that the role is carried out with the relevant accuracy, attention to detail, and following instructions.
• Ensure that judgment and attention to detail are applied to the role.
• Complete the role within required deadlines, having 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.
• Be conscious of the abuse of company resources.

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 members 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 member's record and verified by the bank.
• Ensure all relevant documentation is saved onto the member’s record.
• Ensure all relevant checks are done on the system before processing a claim.
• Meet production standards in terms of quantity (100 assessments daily including payments of 25-30 claims to tax daily).
• Should a query arise at any point, complete the investigation and delegate to the responsible party to resolve.
• Ensure compliance with all controls 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, is dealt with professionally within the service level agreement.
• Ensure all documentation relating to a claim is 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

• Assist alongside other Team Leaders with operations of the team in the absence of the manager.
• Coordinate and monitor all claim-related activities, including the complete claim processing cycle of all claims, all claim-related inquiries 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 propose to implement policies, procedures, and processes that are relevant to the claims team.
• Investigate, analyze, and monitor escalations and complaints. Report trends and obtain approval from the 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 a response to the complainant/Compliance Team within the service level agreement.
• 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 confirmation) 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 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.
• Assist and/or be responsible for drafting and completing Risk and Admin Sub-committee reports.
• Assist and/or be responsible for quarterly reports to actuaries of the Fund.
• Assist and/or be responsible for provision of monthly reports to the Insurer of the funeral scheme.
• Assist and/or be 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.
• The Team Leader is responsible for the overall management of the allocated claims department team, including managing, planning, monitoring, and reporting.
• 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.
• Ensure that all individual team members consistently reach targets for productivity.
• In terms of authorizations, the team leader must ensure that the 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 and calculated accurately.
• Compile and provide accurate reports to the reporting Manager, in the required format by the agreed deadlines.
• Identify, develop, enhance, and implement policies, processes, and procedures relevant to the claims team.
• Manage customer relations for SALT Employee Benefits by communicating relevant and accurate information to customers 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.
• 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.

Qualifications

• 5 - 6 years’ experience in the employee benefits/retirement fund industry, with 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, with at least 2 years practical experience in a leadership role (if external).
• Matric.
• Excel.
• Communication (Written and Verbal).
• English (Business writing and email etiquette).
• Industry knowledge and experience.
• Accuracy and attention to detail.
• Judgment and Decision Making.
• Working under pressure and deadline driven.
• Organizational skills / planning and prioritizing.