Claims Supervisor at Rand Mutual - RMA

Job description

• To effectively and efficiently process Compensation for Occupation Injuries and Diseases as well as other RMA claims within the claims and underwriting functions of insurance products. Ensure regulatory compliance with applicable legislation and internal policies.
• Accountable for day-to-day operations of the team including supervisory and administrative functions. Process and maintain communication between staff and Management.
• Process and maintain communication between staff and Management.

Supervising of Claims Processes:

• Assess claims in terms of medical validity
• Evaluate claims and determine requirements for future management and for decision by RMA Medical Doctors and Claims Committee.
• Prepare communication to members and medical specialists.
• Analyze and synopsize medical reports and other information in context of claims.
• Presentation of claims to RMA Medical Doctors
• Supervise and report on the claims process to ensure customers satisfaction, productivity and cost control in comparison with targets set.
• Supervise the claims cycle
• Supervise reporting of telephonic claims
• Timeous management of Contact Centre enquiries – observe Contact Centre SLA’s
• Monitor and control insurance industry risks as applicable to RMA claims
• Observe ethical standards and comply with all Company policies and procedures
• Liaise and maintain good relationships with all stakeholders
• Supervise administrative functions relating to the claims process and team functioning
• Deal with the appropriate authorities on all matters regarding team and claims
• Carry out all team planning on a regular basis, as issues arise, or in advance of anticipated needs
• Ensure timeous submission of various periodical reports
• Ensure proper housekeeping, safety and security of the Rand Mutual property
• Conduct monthly team meetings
• Communicates effectively with other Teams and management team by sharing information on effective practices and needs
• Address customer and employee’s satisfaction issues promptly

Claims processing

• Overseeing of Claims Processing
• Overseeing of claims and relevant documents within the set targets e.g. MMI, Fatal and pensionable claims, claims cycle
• Supervise and identify risks relating to employer compliance
• Analyze client behavior/compliance and report on employer anomalies and potential risks
• Identifying risks relating to suspicious and fraudulent claims
• Investigate and report on fraudulent claims
• Accurately calculate impairment
• Timeous delivery and accuracy of work completed in accordance with stipulated deadlines
• Identify potential recoveries and reinsurance claims
• Correspondence to stakeholders
• Authorizing of payments within authority limits