Job Description

JOB PURPOSE

To manage the life claims process ensuring the efficient and effective processing



of funeral claims. Mitigating risk and ensuring that only valid claims are paid.



Supervision of the life claims assessors. Assisting the claims manager in dealing



with escalated complaints. Testing of new systems and system enhancements.



To ensure that the life claims department complies with all relevant regulation



and legislation.

RESPONSIBILITIES

Operations Management

Supervise others working within established operational systems.

Customer Management

Manage relationships with clients and act as first point of contact for customer



queries and complaints and resolve these, referring complex issues to others



and ensuring that the customer receives an appropriate response.

Stakeholder Management

Deliver stakeholder engagement activities to support development of effective



project working relationships and to identify and respond to stakeholder needs



and concerns.

Claims Management

Review and analyse assigned claims in line with the organisation's standard



claims procedures and customer service standards. Overseeing 1Life life claim



assessors and performing internal audits. Assisting life assessors with claim



queries to ensure service levels are met. Constant reviewing of claim forms and



claim processes. Approving and paying of all life claims. Ensuring that claim



systems are functional and logging exceptions and enhancements when



required.

Operational Compliance

Maintain and renew a deep knowledge and understanding of the organisation's



policies and procedures and of relevant regulatory codes and codes of conduct,



and ensure own work adheres to required standards. Identify, within the team,



patterns of non-compliance with the organisation's policies and procedures, and



with relevant regulatory codes and codes of conduct, taking appropriate action to



report and resolve these and escalating issues as appropriate.

Performance Management

Respond to personal objectives and use performance management systems to



improve personal performance. Monitor the performance of the team; allocate



work and review completion, take appropriate corrective action to ensure



timeliness and quality; contribute to formal individual performance management



and appraisal.

Work Scheduling and Allocation

Assign short-term work schedules to a team of subordinates in order to achieve



expectations while following established timelines.

Leadership and Direction

Explain the local action plan and targets to support team members in their



understanding of what needs to be done and how this relates to the broader



business plan; motivate people to achieve local business goals and targets.

Organisational Capability Building

Use the organisation's formal development framework to identify the team's



individual development needs. Plan and implement actions to build their



capabilities. Provide training or coaching to others in own area of expertise to



enable others to improve performance and fulfil personal potential. Providing on



the job and formal training to the life assessors.

Insights and Reporting

Prepare and coordinate the completion of various data and analytics reports.

Budgeting and Costing

Requesting NHLS reports and reconciling the billing monthly.

Personal Capability Building

Keep abreast with current changes in internal policies and procedures, external



regulations which are facilitated by the online training system and tracked by a



formal assessment.



Keep up to date with business products and keep abreast of changes in the



insurance industry, including competitor products.

BEHAVIORAL COMPETENCIES

Being Resilient

Rebounds from setbacks and adversity when facing difficult situations. For



example, deals effectively with crises and volatile situations. Puts people's



failures in perspective and helps them move forward. Maintains calm in



adversity; stays objective. Uses hardships and difficult experiences as an



opportunity for personal and team growth.

Directs Work

Provides direction, delegating, and removing obstacles to get work done. For



example, delegates tasks, providing generally clear expectations to staff.



Coordinates and integrates the team's work, reducing duplication. Measures



team progress using the right indicators; recognizes when problems or shortfalls



occur.

Ensures Accountability

Holds self and others accountable to meet commitments. For example, helps



team hold each other accountable for goals, adherence to policies and



procedures. Tracks team metrics and milestones, redirecting effort, as



necessary, for continued progress.

Drives Results

Consistently achieves results, even under tough circumstances. For example,



creates a feeling of energy and an emphasis on excellence in the team, using



productive behaviours. Builds a strong sense of urgency to exceed goals and beat



deadlines. Ensures that the team pushes through obstacles and establishes a



superior track record.

Communicates Effectively

Develops and delivers multi-mode communications that convey a clear



understanding of the unique needs of different audiences. For example, tailors



communication content and style to the needs of others. Pays attention to others'



input and perspectives, asks questions, and summarizes to confirm



understanding.

Customer Focus

Builds strong customer relationships and delivers customer-centric solutions. For



example, solicits customer feedback and data; conveys a clear understanding of



the level of service the team is providing; takes action when standards are not



met by team; aligns business process with customer needs.

Manages Conflict

Handles conflict situations effectively, with a minimum of noise. For example,



responds quickly and constructively to emerging conflicts; redirects those who



engage destructively in conflicts; seeks mutually agreeable outcomes. Maintains



positive and constructive relationships, even under heated disagreements.

Collaborates

Builds partnerships and works collaboratively with others to meet shared



objectives. For example, encourages coworkers and external partners to work



together as a team and makes sure they get credit for doing so. Encourages



people to share their honest views, responds in a non-defensive way when they



do.

Develops Talent

Develops people to meet both their career goals and the organization's goals.



For example, shares own experience and expertise with others if asked.



Provides constructive feedback and other support for other people's



development.

Manages Complexity

Makes sense of complex, high quantity, and sometimes contradictory information



to effectively solve problems. For example, looks at complex issues from



multiple angles; explores issues to uncover underlying issues and root causes.



sees the main consequences and implications of different options.

Manages Ambiguity

Operates effectively, even when things are not certain or the way forward is not



clear. For example, responds effectively to unclear situations, seeks to resolve



ambiguity and make progress. Seeks guidance on how to adapt to changes,



responds with appropriate composure and effectiveness.

SKILLS

Claims Management

Works at an advanced level to handle individual and portfolios of claims cost



effectively, minimising claims leakage, and meeting organisational and customer



claims service standards. Typically works independently and provides guidance.

Customer Service Delivery

Works independently using comprehensive knowledge and skills while guiding



and training others on meeting high customer service standards.

Verbal and written Communication

Apply comprehensive knowledge and guide and train others to use clear and



effective verbal and written communication skills to express ideas, request



actions and formulate plans or policies.

Action Planning and Work Scheduling

Uses comprehensive knowledge and skills to work independently while providing



guidance and training to others on developing appropriate plans or performing



necessary actions based on recommendations and requirements.

Computer and System skills

Support business processes by understanding and effectively using standard



office equipment and standard software packages, while providing technical



guidance as needed.



Intermediate Excel and Word

Customer and Market Analysis

Conducts research and analyses data with guidance (but not constant



supervision) to develop a comprehensive understanding of customer



and market conditions that enables maximum return on investments.



Knowledge of products and brand.

Compliance

Provide technical guidance when required to achieve full compliance with



applicable rules and regulations in management and/or operations.

Policy and procedures

Provide technical guidance when required to develop, monitor, interpret and



understand policies and procedures, while making sure they match



organisational strategies and objectives.

Reporting

Applies comprehensive knowledge and skills to work independently while



providing guidance and training to others on creating relevant, lucid and effective



reports.

Data Management

Applies comprehensive knowledge and skills to work independently while



providing guidance and training to others on acquiring, organising, protecting



and processing data to fulfil business objectives.

Learning and Talent Development

Provide technical guidance when required to motivate all employees to learn,



grow and develop so that they can obtain the knowledge and experience they



need to help the organisation reach its goals.

Builds Rapport

Works without supervision and provides technical guidance when required to



quickly and effectively establish trust within the buying centres in the client's



organisation.



Confirms understanding, incorporates client's point of view, Provides relevant



context, reinforces professional capability, Respects the client's time, Shows



empathy with buyer's circumstances

Analytical Skills

Works without supervision and provides technical guidance when required on



supporting research schedules using appropriate analytical processes and



procedures.

EDUCATION General Education

Matric / Grade 12 or SAQA Accredited Equivalent (Essential) Regulatory Exam 5 (Advantageous); NQF5 Wealth Management qualification (Advantageous) Class of Business (Advantageous) RE1 and ASISA Claims Assessor Course (Advantageous)

EXPERIENCE General Experience

5 or more years funeral supervision experience within the long-term insurance industry (Essential) 3-5 years junior claims management experience in the life underwriting environment (Advantageous) relevant medical insurance knowledge (Essential)

Managerial Experience

1 or more years' experience of supervising and directing people and other resources to achieve specific end results within limited timeframes (advantageous)

ADDITIONAL INFORMATION

SAQA Accredited Equivalent - it is the onus of the applicant to provide 1Life and its subsidiaries with certified evidence that their qualification(s) meet the equivalent NQF level required for this role at time of application. Financial Sector Conduct Authority (FSCA) competency requirements: FAIS recognised qualifications / Regulatory Examinations / Class of Business Certification and / or CPD according to your DOFA (where applicable). As a registered Financial Service Provider, we are mandated to ensure that all our representatives are and remain fit and proper at all times. By applying for this role, you consent to having your relevant qualification and or accreditation or confirm that you are working towards meeting the competency requirements. You further consent to the relevant information being verified.