Job Description

Closing Date 2026/03/31
Reference Number MMH260127-24
Job Title Talent Pool: Head: Claims Risk Management
Position Type Permanent
Cluster Momentum Health
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Sandton
Introduction
Through our client-facing brands Momentum Group, 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.
Role Purpose
To oversee that the Health Investigations Unit (HIU) executes its deliverables in line with legal rules, regulations and set service level agreements, whilst managing claims risks and maintaining expectational service to respective stakeholders.
Requirements
EDUCATION

• Matric (Essential)
• Bachelor degree or equivalent qualifications in a relevant field such as business administration, finance, risk management, compliance, or a related discipline (Essential)
• Professional certifications related to risk management and compliance (e.g., Certified Risk Manager (CRM), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), Certified in Risk and Information Systems Control (CRISC), and Certified Regulatory Compliance Manager (CRCM) (Desirable)

EXPERIENCE AND KNOWLEDGE

• 5 - 8 years' experience in risk/compliance or relevant equivalent experience
• 2 - 3 years' management/leadership experience
• Finance/Insurance industry experience
• Knowledge of risk management principles, practices, and methodologies.
• Knowledge of process improvement methodologies such as Lean Six Sigma or similar approaches.
• Understanding of quality management principles and practices.
• Knowledge of financial management principles and practices.
• Familiarity with governance frameworks, compliance requirements, and best practices.
• Ethical conduct, legal obligations, and professional standards relevant to the role.
• Healthcare systems, terminology, and processes (Desirable)
• Healthcare-specific risk management knowledge (Desirable)

Duties & Responsibilities
PROCESS

• Engage and collaborate with internal stakeholders to streamline processes, fostering synergies, and enhancing operational efficiency while adhering to relevant control and risk frameworks.
• Plan, coordinate, and supervise a team to achieve objectives, ensuring compliance with industry-specific control and compliance requirements.
• Develop and implement sustainable processes focused on client experience, risk minimisation, and alignment with the organisation's direction, incorporating control frameworks.
• Establish internal quality management processes to ensure client service meets expectations and compliance requirements..
• Communicate updates and progress to relevant stakeholders, highlighting compliance-related issues and collaboration with compliance teams.
• Foster a culture of rewarding relationships, feedback, and exceptional client service, integrated with compliance considerations.

CLIENT

• Build and maintain strong relationships with employees, clients, and internal/external stakeholders.
• Exceed client and stakeholder expectations, aligning exceptional service with compliance requirements.
• Make recommendations to enhance client service, considering risk and compliance impact.
• Monitor turnaround times and quality, promptly resolving issues to optimize compliant client service.
• Manage client query processes, ensuring accurate and timely resolution while utilising queries as opportunities for improvement.
• Foster collaboration with members of the Service Provider Network (SPN) to promote the organisation's strategic objectives.
• Communicate claims risk issues to committees, proposing compliant mitigation strategies.
• Demonstrate the value derived from claims risk interventions to key stakeholders.

PEOPLE

• Cultivate a positive work climate and culture that energises employees, adds meaning to their work, minimises disruptions, and maximises productivity.
• Drive a culture of best practices, excellence, continuous learning, improvement, and teamwork.
• Effectively manage team performance to achieve business objectives.
• Encourage innovation, adaptability to change, and collaboration within the team.
• Lead by example, engaging personally, committing, and dedicating support to organisational values.
• Recruit and select qualified talent in line with Employment Equity principles and organisational values.
• Foster a culture of learning and growth, actively sharing information and encouraging the development of team members.
• Conduct effective workforce planning to accurately forecast staffing requirements.
• Identify employee growth and development needs, schedule interventions, and facilitate ongoing training and personal growth.

FINANCE

• Manage financial and company resources responsibly and efficiently.
• Control the budget for the designated area, including expenditure authorization, financial controls,
• Achieve annual financial targets, including effective management of leave balances and absenteeism.
• Develop and implement budgets to minimise expenditure, aligning with tactical delivery plans.
• Manage high-risk and complex financial issues within the defined scope of accountability and contribute to policy development.
• Plan and implement a cycle of medium-term improvements to drive pricing of services and products.
• Implement and manage financial risk methodologies, techniques, and systems to monitor and report on financial activities.
• Provide feedback on the effectiveness of financial policies, practices, and procedures, ensuring compliance and ethical conduct.
• Implement risk management, governance, and compliance policies within the designated practice area to identify and manage governance and risk exposure liability.
• Investigate reported wilful acts of non-compliance to organisational policy and practice, and report findings accordingly.

Competencies

• Developing Strategies Is focused on developing strategies; thinks in the longer term and anticipates trends; envisages the future and adopts a visionary approach.

• Making Decisions Is determined and decides on actions; willingly assumes responsibility; is definitive and stands by own decisions.

• Directing People Is comfortable leading people; coordinates and directs groups; seeks to control things.

• Upholding Standards Behaves ethically and justly; is discreet and maintains confidentiality; meets commitments by acting with integrity.

• Meeting Timescales Is target focused and meets deadlines; is punctual and keeps to schedule; is reliable in finishing tasks.

• Articulating Information Is articulate in giving presentations; is eloquent and explains things well; projects social confidence when articulating information.

• Managing Tasks Manages tasks by being organised and methodical; plans activities systematically; sets priorities for tasks.

• Examining Information

Analyses and processes information; asks probing questions; strives to find solutions to problems.
Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Skills Required