Job Description

Introduction

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

This role offers exciting and challenging opportunities for a dynamic, performance-oriented, knowledgeable, and experienced individual. The candidate must deliver quality outputs in a fast-paced, high-volume client-oriented environment, excelling both independently and as part of a team. This position is essential for maintaining and improving the quality standards across the organisation, ensuring exceptional client service and operational efficiency.

Requirements

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Qualifications

Valid Matric Certificate
Proven process specialisation with a medical scheme administration
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Knowledge

Experience in quality assessment within a medical scheme administration business.
Subject management experience relative to allocated stakeholder areas and proven proficiency at an advanced level.
Strong performance orientation.
Knowledge of the scheme's rules and benefits.
Competence in generating quality and statistical reports.
Familiarity with all operational processes employed within the administration business.
Proven specialisation in delegated process focus areas
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Skills

Ability to remain impartial
A high focus on customer expectations and experience
Ability to maintain cooperative working relationships
Ability to work independently and as part of a team.
Ability to give constructive feedback and coach
Analytical and problem-solving skills with the ability to make decisions
Ability to communicate recommendations in a constructive manner
Excellent interpersonal skills and communication skills (both written and verbal)
Strong client service and relationship management skills.
Collaboration
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Experience

More than 2 years proven experience within designated process focus area within a medical scheme administration business
Proven specialisation courses within designated process focus area within a medical scheme administration business
Proven exceptional quality scores / outcomes in experience process areas

Duties & Responsibilities

INTERNAL PROCESS

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Conduct daily quality checks for all operational areas as directed by the scheme, including:

Correspondence management
Call- and Walk in Centre operations
Enquiry management
Claims processing
Ex-Gratia
Membership services
Underwriting
Customer Experience
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Weekly Quality Checks:

Ensure revision of cases shared by the technical department and relevant updates on the quality assessor (QA) Database.
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Coaching:

Notify employees assessed of QA outcomes timeously.
Schedule and conduct coaching sessions with employees assessed to address shortcomings.
Ensure awareness of QA scores and QA interventions with direct reports of assessed employees.
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Record Keeping:

Maintain valid, accurate and complete, and up-to-date records of employees assessed in line with agreed quality assurance frameworks as to ensure value driven trend and statistics can be shared with various internal and external stakeholders.
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Issue Notification:

Promptly notify team coaches of specific issues to ensure timely instructions (memos, guidelines, etc.) are issued to staff.
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Error Investigation:

Ensure accurate root cause analysis of errors are done as to ensure appropriate mitigation measures will be employed from or a combination of People, Process or System enhancements.
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Meetings:

Attend and constructively participate in stakeholder meetings as to ensure that QA learnings are appropriately shared with stakeholders.
Ensure timely completion of investigations and tasks arising from meetings.
Conduct regular engagements with assessed employees and leaders.
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Continuous Development:

Stay informed about developments within Metropolitan Health, but specifically with regards to any People, Process and System changes within assigned stakeholder areas.
Ensure communication of these changes with QA leaders as to ensure that the necessary alignment from a QA training and QA process alignment is done.
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Computer Literacy:

Maintain computer literacy relative to operating platforms and QA applications.
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Knowledge enhancement:

Have a thorough understanding of the scheme's Rules and Benefits and ensure to attend annual updates in this regard.
Ensure up to date knowledge for allocated areas of responsibility to be a subject matter expert and proactively drive enhancements.
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Quality Statistics Reporting:

Capture quality outcomes for all assessments as to allow for detailed quality reporting and insights to be shared with various internal and external stakeholders.

CLIENT

Build and maintain relationships with designated stakeholder groups (including clients & internal stakeholders)
Deliver on service level agreements applicable to clients and internal and external stakeholders to ensure that client expectations are managed.
Make recommendations to improve client service and fair treatment of clients within the area of responsibility.
Participate and contribute to a culture which builds rewarding relationships, facilitates feedback, and provides exceptional client service.
Continuously monitor turnaround times and quality standards and resolve issues swiftly to enhance client service delivery.
Manage client query processes, ensuring queries are tracked, accurately resolved, and used as a mechanism to improve client service and business processes.

PEOPLE

Build strong relationships by providing specialist know-how and leadership to others, expressing positive expectations.
Continuously develop own expertise in industry and subject matter, applying it in specialisation.
Positively influence and manage change, offering specialist support where required.
Contribute to continuous innovation through the development, sharing, and implementation of new ideas and involvement of colleagues and staff.
Participate and contribute to a culture of work-centric thinking, productivity, service delivery, and quality management.
Take ownership of driving career development.

FINANCE

Contribute to the development of area-specific budgets to minimise expenditure, aligning with operational plans.
Identify solutions to enhance cost-effectiveness and increase operational efficiency.
Implement and provide input into governance processes and systems within the area of specialisation.
Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution.:
Provide input into the risk identification processes development and communicate recommendations in the appropriate forum as to ensure QA framework alignment.

Competencies

Ability to remain impartial
A high focus on customer satisfaction
Ability to maintain cooperative working relationships
Ability to work under pressure and work independently
Ability to give constructive feedback and coach
Analytical and problem-solving skills with the ability to make decisions
Ability to communicate recommendations in a constructive manner
Excellent interpersonal skills and communication skills (both written and verbal)
Sound knowledge of scheme rules and benefits
Be able to interpret payment instructions from relevant Service Provider Network's (SPN)
Leads Change and Innovation
* Collaboration