Capitec Claims Team Leader at Sanlam Group

Sanlam Developing Markets (SDM) (a wholly-owned subsidiary of Sanlam Life Limited) is one of the top financial services providers in the South African entry-level and emerging middle market. It aims to understand the unique requirements of clients and offers a wide range of simple and affordable financial solutions that cover needs such as funeral insurance, savings for education, life cover and personal accident plans. In terms of the Sanlam Group Governance Policy, SDM is managed by the SA Retail Mass cluster, which is part of the Sanlam Life and Savings cluster within the Sanlam Group. There are four businesses within the SA Retail Mass cluster, namely; Group Benefits, Individual Life, Safrican Insurance and African Rainbow Life.

What will you do?

• Manage claims assessor performance and be able to manage poor work performance where required, as per compant process.
• Manage hourly, daily, and monthly productivity of staff to achieve required targets.
• Conduct monthly feedback sessions with staff and document each feedback session.
• Ensure performance appraisals and development feedback are provided and documented for all staff.
• Manage 80% of claims assessed within the 4 hour SLA target.
• Manage and ensure only less than 10% of claims received are carried over to the next day on the capitec claims queue.
• Ensure staff are at 100% adherence to the Capitec SOPs.
• Monthly review of red flags and referral criteria, and continuous review of processes to ensure efficiencies.
• Bi-annual review of claims requirements to be able to provide feedback to Capitec.
• Ensure all claims reffered to validations are timeously processed and communication is provided to Capitec within the SLA.
• Monitor and manage claims reffered to specialised support documents are finalised within the SLA and feedback/progress is provided to Capitec.
• Monitor and ensure that all refund claims are paid within the 24 hour SLA.
• Identify processes within claims where optimum efficiencies may be achieved through the process of automation.
• Conduct daily recons of claims sent by Capitec and claims referred to Centriq for repudiation sign-off.
• Monitor fraud trends and provide recommendations for relevant changes to be implemented to close the identified gaps.
• Document weekly, montly, and quarterly reports on the overall Capitec claims performance.
• Engage with multiple stakeholders to ensure all processes and requirements are accurately defined.
• Ensure staff undergoes yearly fraud and risk training.
• Manage stakeholder relationships to ensure alignment on processes and improve stakeholder engagement.

What will make you successful in this role?

• Matric
• Diploma / Degree would be an advantage
• 3 year relevant experience in a similar environment essential
• Proficiency on MS Word,& Excel (intermediate level) essential
• Computer literate
• Communications skills (written and verbal)

Qualification And Experience

• Grade 12 with 3 to 4 years related experience.