Claims Audit Team Leader (12-Month Contract) – Centurion
Finance / Accounting
Centurion – Gauteng
Claims Audit Team Leader (12-Month Contract) – Centurion
Salary: up to R 668,708.00 pa (Based on experience)
Purpose of the role:
The Team leader: Claims Audit is responsible for supervising and coordinating the inspection, verification and quality assurance of backlog claims files and recommend referral for further assessment/escalation in line with the findings.
Minimum Requirements and Experience:
- Bachelor’s Degree/ Advanced Diploma in:
- Public Administration
- Business Management
- Quality Assurance
- Compliance
- Legal related qualification.
- Relevant 5 years’ Quality Assurance experience in:
- Claims administration related environment of which 2 years must be on the supervisory level in operations management function.
- Knowledge of Claims management process/ processes and systems:
- (including handling, verification and validation, investigation, assessment/settlement, litigation, legal costs assessment and settlement).
- Experience in the public sector would be advantageous. (PFMA)
- Persons with disabilities (PWD) are encouraged to apply.
Key Performance Areas:
Audit operations coordination
- Coordinate daily audit activities and allocate backlog claim files to Officers and Administrative assistants
- Monitor daily audit volumes, output quality, productivity, stage ageing and turnaround times.
- Provide first-line technical guidance to the team.
- Ensure the audit team applies consistent standards when determining whether a file can progress, settle, close or be routed for further action.
Workflow and routing management
- Ensure claims are routed to the correct stream with clear workplans and outstanding actions.
- Review routing decisions on complex, unclear or high-risk matters.
- Monitor time spent at each processing stage or hub and identify bottlenecks.
- Coordinate handover with referral workstreams
- Manage productivity.
- Escalate recurring workflow failures, incorrect routing and dependency delays.
Exception Handling
- Maintain an exception register for high-risk, disputed, dormant, litigated, prescribed or unclear-routing matters.
- Resolve first-line technical exceptions and escalate unresolved matters to the Manager: Backlog Audit.
- Track matters with missing critical information, system discrepancies, unresolved mortality status, disputed merits or incomplete medical/HPCSA records.
- Coordinate with relevant business units to obtain clarifications and unblock processing.
- Monitor closure of exceptions and corrective actions.
Quality assurance and technical review
- Conduct sample reviews of audit outputs for completeness and accuracy.
- Check quality of Home Affairs mortality verification, old/new system reconciliation, prescription expiry recording and payment history review.
- Provide coaching and corrective feedback to improve file audit quality.
Stakeholder Management
- Coordinate day-to-day communication with related working hubs for seamless handover and referrals.
- Facilitate feedback on handovers, dependencies and routed matters.
- Support resolution of audit-related queries and information gaps.
- Represent the audit team in operational discussions where delegated.
- Maintain professional working relationships and service standards.
Reporting
- Compile daily, weekly and ad hoc audit reports.
- Report on audit volumes, productivity, stage status, ageing, product-stream classification, routing outcomes, settlement readiness, closure recommendations and dormant file matters.
- Analyse trends and recurring issues from audit outcomes.
- Provide management information to the Manager: Backlog Audit and programme structures.
- Monitor action plans arising from quality findings or operational issues.
People Management
- Ensure the motivation, cohesiveness, and alignment of the organisation’s team members.
- Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of The Company.
NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.
