Claims Audit Manager (12-Month Contract) – Centurion
Finance / Accounting
Centurion – Gauteng
Claims Audit Manager (12-Month Contract) – Centurion
Salary: up to R1,028,791.00 per annum (Based on experience)
Purpose of the role:
The Manager: Claims Audit is responsible for the efficient management of backlog Claims files initiatives.
Minimum Requirements and Experience:
- Bachelor’s Degree/ Advanced Diploma in:
- Public Administration
- Business Management
- Quality Assurance
- Compliance
- Legal related qualification.
- Postgraduate Diploma in:
- Public Administration/ Business Management/ Quality Assurance/ Compliance related qualification will be an added advantage Experience
- Relevant 6-8 years’ Quality Assurance experience in:
- Claims administration/ Claims Compliance related environment of which 2 (two) years must have been on a management/supervisory level.
- Experience in:
- Claims management process/ processes and systems (including handling, verification and validation, investigation, assessment/settlement, litigation, legal costs assessment and settlement).
- Knowledge of Motor Vehicle Accident legislation.
- PFMA knowledge.
Key Performance Areas:
Policy review and implementation
- Contribute to the development and implementation of departmental policy, procedures, and processes.
- Keep up to date with effective policy and practice execution strategies. Management of Backlog audit initiatives.
- Manage the Audit Hub as the front-door control point for backlog claim status determination, routing, readiness certification, and closure recommendation.
- Ensure mortality verification, claimant validation and outstanding information identification are performed in line with the approved scope.
- Oversee correct product-stream classification for funeral, loss of support, general damages, and loss of earnings matters.
- Ensure claims are routed with clear workplans and next actions to reduce rework and improve throughput.
- Monitor hub performance against productivity, quality, ageing, dependency, and routing requirements.
- Monitor operational, legal, financial, compliance, quality and reputational risks arising from backlog audit activities.
- Recommend process improvements, control enhancements, and corrective action. Quality Assurance
- Establish and monitor quality assurance standards for claim audits, routing decisions, readiness assessments, and closure recommendations.
- Ensure quality reviews test completeness of mortality verification, system reconciliation, prescription recording, payment history, product classification, and status determination.
- Monitor quality trends, incorrect routing, incomplete files, stage status errors, and recurring audit weaknesses.
- Ensure corrective actions are implemented and tracked.
Exception Handling:
- Manage exception handling for complex, dormant, litigated, prescribed, system-discrepant, medical/HPCSA, court order and writ-linked matters.
- Ensure exception registers are maintained and reviewed.
- Direct escalations to Legal, Compliance, work stream hubs or executive structures where required.
- Monitor matters that may expose the Fund to operational, legal, financial, or reputational risk.
- Analyse exception trends and implement process improvements.
Reporting
- Develop and submit operational reports as required.
- Report audit volumes, claim status outcomes, stage ageing, routing, quality, exceptions, closure recommendations, dormant matters, settlement readiness, and legal exposure.
- Ensure performance information is accurate, timely and supported by auditable source data.
- Escalate material risks, bottlenecks, corrective actions, and project dependencies.
Stakeholder Management
- Manage relationships with related workstream hubs and other project stakeholders.
- Facilitate communication between the Audit Hub and receiving workstreams.
- Resolve handover, dependency, information, and routing issues.
- Represent the Audit Hub in relevant governance and operational forums.
- Ensure professional engagement with service providers and external stakeholders where required.
People Management
- Ensure the sourcing, development, and retention of a high-performance team.
- Manage the recruitment of the operational workforce in line with employment equity targets.
- Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of The Company.
- Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
- Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.
NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful
