Claims Processing Manager

SUMMARY:
Manage the Benefits Investigation and claims processing function, ensuring the provision of professional support services to the surviving dependents/beneficiaries (for informed allocation of benefits) to the correct beneficiaries in compliance with the Fund rules, Section 37C of the Pension Funds Act and related Acts. Ensure the timeous and accurate payment of benefits, manage issues associated with claims and benefit administration

POSITION INFO:
Manage internal departmental functions and processes

• Develop and implement plans for the section that support Pension Administration and the company's objectives, ensuring optimisation of current business and workflow processes.
• All benefit processing activities in accordance with the benefits as defined in the rules of the Fund and applicable legislation.

• Provide interpretation advice on the application of the Rules of Fund.
• Ensure that audit controls are in place and audit requests are followed up.
• Participate on the defined Committees (Benefits Committee (BC), Medical Panel (MP), Management Benefits Committee (MBC)) and take decisions based on formal documentation.

• Participate in the Fund’s overall projects as required with continuous focus on Business Processes, system enhancements, omni channel business insight, contributing expertise to enable project objectives to be met.
• Draft reports as part of the project deliverables.

• Contribute ideas for improved service delivery at Management meetings.
• Compile comprehensive business reports for this function, highlighting successes and risks in terms of achieving the section’s objectives.
• Keep abreast with changes in relevant guidelines and other legislation, to make recommendations where policies and procedures need to be amended.

• Manage investigations on death benefit cases confirming dependency with recommended benefits allocation percentages for approval by Benefits Committee.
• Monitor that outstanding banking details for payment of approved death benefits are followed up, and confirmed.
• Verify that death benefits allocation reports produced are legally compliant with recommendations and reflect minimal errors.

• Implementation of decisions, requests and referred cases, with reports and recommendations being submitted to BC, MP& BP or other internal departments.
• Ensure compliance with Fund rules and legislation to suspension, addition, termination and reinstatement of beneficiaries (widows and minor children) in compliance.

• Forecast annual capital and operational expenses for the section in line with corporate policy.
• Manage costs against approved budget.
• Investigate methods to contain / reduce costs.

• Ensure compliance to procedures and relevant legislation
• Provide detailed, accurate information for internal and external audit purposes within specified deadlines.
• Action audit issues identified within time frames indicated.
• Implement controls within the section which minimize potential risk to stakeholders.

• Relevant Bachelor’s Degree, preferably in Law. Registered with professional bodies - where applicable
• At least 6 years job-related experience, which should include at least 2 years’ experience in a management role
• Knowledge of an African Language is an advantage
• Working knowledge of Pension Fund Rules
• Basic knowledge of Income Tax Act, Divorce Act, Pension Funds Act, Child Care Act, Marriage Act, Recognition of Customary Marriage Act, Mental Health Act
• Working knowledge of Benefit administration
• Knowledge of Law - Section 37 (C) allocation of death benefit lump sums
• Valid driver’s license

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