Join TIH, home to some of South Africa’s leading financial service providers, and grow your career while being part of an organisation with purpose.

Job Purpose

Review, vet and endorse decisions on all claim types handled in the Claims Operational area to control associated claims cost efficiently and risk controls associated with claims decision making.

Responsibilities

Operational Compliance

Identify, within the team, instances of non-compliance with the organisation's policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these and escalating issues as appropriate.
Check claims put forward for decision or amendments to original decision as well as all other supporting decisions taken throughout the claims process by adherence against the required standard.
Identify trends of non-adherence to specific rules and guidelines.
Escalate disputed recommendations to business managers in the relevant operational area for dispute resolution purposes.
Uphold agreed service level agreements (set turnaround times) to ensure customer satisfaction and retention.

Data Collection, Analysis, Insights and Reporting

Conduct research using primary data sources and select information needed for the analysis of key themes and trends.
Report trend findings to Manager Risk and Decision Making.
Evaluate the effectiveness of rules, guidelines and processes application.
Keep record, measure and track performance agreed standards to inform decision making in the relevant area of responsibility.
Request additional validation on claims to enable the approval or denying of claims.

Improvement / Innovation

Identify shortcomings and suggest improvements to existing programs, processes, systems and procedures, then delivers a plan for a small element of a change management program with guidance from a senior manager.
Make recommendations for implementation on continuous improvement opportunities pertaining to rules, guidelines and processes.

Recommendations

Advise managers how to apply a wide variety of existing procedures and precedents.
Provide final sign off and endorsement of decisions put forward.
Provide detailed input to line managers to enable coaching initiatives.

Stakeholder Engagement (Internal & External)

Contribute to stakeholder engagement through identifying stakeholders, finding out their needs/issues/concern and reacting to these by arranging meetings and events and drafting supporting materials to promote understanding and commitment.
Provide support and assistance to claims processors on complicated or unusual claims.
Effectively build, maintain and manage relationships with service providers, suppliers and colleagues.

Education

Grade 12/ SAQA Accredited Equivalent (Essential); FAIS recognised qualification (Essential) (Required)

Experience

5 or more years claims administration and validation experience in a claims department within the short-term insurance industry (Essential); 2 or more years experience in a claims decision making role within a claims department within the short-term insurance industry (Essential); 2 or more years experience working with internal claims operating systems (Advantageous).

Think you have what it takes to be part of an unstoppable team who constantly finds better ways to give peace of mind? Don't wait, apply now.