Fresh Jobs at Rand Mutual - RMA

THE JOB AT A GLANCE

As the Pensions Medical Case Auditor (PMCA), you will be responsible for effectively and efficiently rendering medical support to internal and external stakeholders.

WHAT WILL YOU DO?

• Monitoring of Hospital Admissions weekly and liaison with Case Managers.
• Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
• Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
• Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
• Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
• Visit medical service providers and hospitals to address Pensioners related issues
• Organize and attend scheduled clinics.
• Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
• Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
• Organizing uro reviews and capture the uro report.
• Organize prosthetic review clinic and load report on CC2.
• Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
• Assist with medical walk-in office clients.
• Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
• Assist with education of pensioners on entitlements.
• Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
• Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
• Manage visa and passport expiry documents of SCI pensioners in Hospital.
• Managing and control of medical expenses as per yearly plan
• Follow up, from RMA system generated reports, high cost claims based on type of injury and estimated costs.

WHAT YOU'LL BRING TO THE TABLE?

• Nursing diploma /degree
• 3  years nursing experience as professional nurse
• Valid Driver’s License
• Registration with Nursing Council or relevant Health Professional Council
• Building Customer Loyalty
• Contributing to Team Success
• Managing Work (includes Time Management)
• Stress Tolerance
• Decision Making
• Confidentiality
• Credibility
• Friendly
• Initiative
• Integrity

WHAT WILL YOU GET IN RETURN?

This is an exciting opportunity within the Rand Mutual Assurance team, offering exposure to an interesting combination of technical and business issues. This is a great time to join RMA as we look to grow the Life business and develop our actuarial team.

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THE JOB AT A GLANCE

 As the Process and Systems Manager, you will be reporting into the Head of QA. You will be responsible for leading, managing, and deploying process change programs across the Group in order to provide end to end solutions, establishing an approach and methodology through which business process management can be driven throughout respective business units, to improve operational efficiency and effectiveness. You will also be responsible for collaborating with Exco and Manco on the strategic intent of RMA, aligning the business architectural landscape to ensure effective and efficient business value streams, optimal integration of processes, people and technology by analysing, researching, designing, recommending and implementing innovative and cost-efficient business processes across the Group through effective leadership of a cross-functional team.

WHAT WILL YOU DO?

Process Architecture and Business Optimisation

• Establish RMA Process Architecture in line with business operating model, by defining decomposition levels across business areas.
• Establish RMA Process Taxonomy by defining process classification, and review periods, to meet operational, compliance, risk and quality management requirements.
• Support the strategic Business Process Management compilation and execution across the Group, in line with the QA Framework, for business efficiency to improve customer and stakeholder experience.
• Confirm process hierarchies defined across the Group, translating those into the Group operational value chains to ensure alignment and seamless synergies between and across the teams, across the Group.
• Compile and implement standardized business process improvement and re-engineering methodologies, in line with the QA framework, for continual improvement.
• Lead and guide the team in business process improvement initiatives aimed at improving efficiencies and operational effectiveness across the Group.
• Assist the team in performing business diagnostics to assess process maturity levels, putting plans in place for maturity improvement.
• Ensure that processes and procedures as well as system designs are integrated into single business solutions.
• Apply scientific principles and best practice approach to refine and re-engineer as-is processes and to the to-be processes that enhance customer experience and profitability.
• Provide input into the documentation, formalization and validation of conceptual designs proposals that define best scenarios to respond to customer needs and expectations.
• Facilitate and integrate process design, improvement and maintenance amongst role players across the Group.
• Proactively participate in business efficiency improvement forums and play an active role in process change initiatives by assessing and recommending the feasibility of change requests received.

Understand existing systems and business models to support business needs and requirements

• Liaise with Exco and Manco to identify, assess, and document business requirements.
• Approve potential solutions for both technical and business suitability, in line with the QA Framework.
• Strategise new solutions based on business requirements, for improved efficiencies that will improve customer experience.

Research and Innovation

• Manage costs Research process improvement best practice and methodologies, for feasibility and application.
• Research industry market trends with respect to products, services, process and technology enhancements for suitability and application.
• Proactively identify opportunities to improve current solutions and processes through automation, in line with the QA Framework.
• Provide expertise and share best practices regarding Process Improvement tools, methodologies, and team leadership, embedding quality assurance in line with the QA Framework, compliance and legislative requirements, technology innovation, and governance, ensuring adherence to methodologies and standards by all contributors.
• Engage with technology partners for technology related matters- hardware, software, infrastructure and support.
• Benchmark RMA technologies, practices and operating models in comparison to best practice.
• Promote and develop a culture of continuous improvement across the Group, for an improved customer experience.
• Attend seminars, conferences and public invitations related to process improvement methodologies, technology, system engineering and industry related topics.
• Actively participate in industry forums- industrial engineering, Lean Six Sigma best practice discussions to keep abreast of industry trends.

Team Management

• Motivate, lead and coach the Process and Systems Engineering team to support business requirements towards achieving goals and targets
• Consult and strategise with business unit leaders to achieve goals and targets
• Pursue team’s development to continually improve skills and personal effectiveness, acknowledging strengths and areas of improvement, and the implementation of their personal development plans
• Mentor and coach cross functional teams in approved methodologies, best practise and problem-solving skills for continual improvement
• Foster a culture of collaboration, teamwork and continuous improvement within the team and across the Group
• Adhere to the RMA values and polices and consistently behave in an honest and ethical way
• Maintain a strict sense of professional ethics, maintain confidentiality and privacy and abiding by Company Policy

Project Management

• Manage and assist to coordinate the implementation efforts of enhancements and change initiatives, ensuring that change impact is effectively controlled
• Conduct business impact analysis in liaison with line managers on any change that is imposed on the current operational environment
• Apply basic methodologies to identify bottom line and economic profit enhancement opportunities where it relates cost efficiencies or income enhancement
• Lead the team to execute medium/high impact performance improvement project objectives to achieve desired quality and impact within timelines planned and within approved budget across the Group
• Ensure a smooth transition to re-designed processes and provide project support to set up, manage and control projects throughout their lifecycle
• Maintain interaction with business analysts and project managers to create synergies before, during, and after process re-engineering and implementation
• Interact and attend meetings and workshops to ensure that major change and small enhancement initiatives impacts are pro-actively identified so that implementation can be coordinated
• Facilitate ad conduct Joint application Design (JAD) sessions with cross functional teams to identify improvement opportunities
• Lead and manage project stakeholder communication and management throughout the lifecycle of process projects
• Identify and manage work stream interdependencies, risks and issues affecting successful delivery of projects
• Set up processes to monitor and manage changed processes, and maintain their sustainability, tracking benefits in line with process improvement methodologies
• Deliver QNI (Quality Net Income) and financial savings though projects
• Provide support to the Business Engineer as technical lead for projects, interacting with business partners to collaboratively define solutions to address key opportunities
• Identify impact of process change on job descriptions of staff that execute the work within the processes, and recommend training requirements to bridge the gap

Reporting

• Use appropriate templates and channels to report on progress on a weekly and monthly basis, in line with the QA Framework and Governance structures agreed
• Adhere to deadlines and ensure accuracy and quality

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 7: BSc Industrial Engineering Degree/BCom/BSC Degree required
• Relevant diploma/degree in commerce/admin/insurance or equivalent
• Lean and Six Sigma Certification (Black Belt/Master Black Belt)
• Business Analysis training (advantageous)
• Business Architecture training (TOGAF) advantageous
• Project Management training/ qualification 
• 8 – 10 years’ experience in Business Process engineering; Process Modelling / Analysis and Design
• Minimum 6 years’ experience using leading methodologies and processes (e.g. Lean/Six Sigma, DMAIC, TQM, ISO or similar)
• 4 – 5 years’ leading a team of specialists
• 3 – 5 years systems understanding
• Experience in managing multiple parties including Project Managers and service providers on innovative solutions
• High level computer literacy with the following applications – Microsoft suite, Visio, MiniTab, MS Project
• Sound, proven experience in implementing and improving business processes
• Basic training in Business Analysis
• Systems experience (understanding of system structure and functioning)
• Proven ability to influence and affect change at all levels of the organization.
• Ability to build and manage effective project teams, perform effectively within budgetary guidelines and is decisive and confident, with the ability to energize others
• Proven leadership experience across multifunctional projects across business units
• Experience with deploying aspects of large-scale business transformation projects. Ideally, you have managed, lead and developed project teams across medium sized financial service institutions (banking, insurance, or finance)
• Good understanding of insurance and financial systems and technologies
• Ability to ensure compliance to all regulations and processes
• Ability to negotiate change and positively influence peers
• Insurance or Financial Services experience advantageous

WHAT WILL YOU GET IN RETURN?

We offer great opportunities for personal and professional development in a stable company that’s 127 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

Turnaround time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days please consider your application unsuccessful.

Closing date: 8 December 2022

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Description

THE JOB AT A GLANCE

As the Team Leader Senior Claims Assessor, you will be reporting into the Claims Manager. You will be responsible for supervising and managing a team of Senior Claims Assessors who be adjudicating, and processing claims based on Rand Mutual Assurance guidelines.

WHAT WILL YOU DO?

Supervise and manage a team of Senior Claims Assessors

• Assess claims received in line with company policies and standard operating procedures
• Evaluate claims received and determine requirements i.e. medical reports, Statement of Earnings for adjudication
• Evaluate and determine requirements for claims to be presented to RMA Medical staff and Technical Committee for decision making
• Analyse and synopsize medical reports and other information in context of claims
• Supervise and report on the claims process to ensure customers satisfaction, productivity and cost control in comparison with targets set
• Timeous management of Contact Centre enquiries in line with agreed Service Level Agreements
• Ensure adherence to ethical standards and compliance with all Company policies and procedures, as well as regulatory requirements
• 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 the 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
• Conduct monthly team meetings and individual one on ones
• Communicate effectively with other Teams and management team by sharing information on best practices and needs
• Ensure timeous processing of payments
• Ensure quality of work is of high standard

Process claims

• Manage the claims processing cycle
• Oversee the processing of claims
• Supervise and identify risks relating to employer compliance
• Analyse client trends and report on anomalies and potential risks
• Manage the identification of risks relating to suspicious and fraudulent claims
• Initiate claim investigations and report on fraudulent claims
• Ensure timeous delivery and accuracy of work completed in accordance with stipulated deadlines
• Manage the identification of potential recoveries and reinsurance claims
• Identify potential increased compensation (Section 56) claims and notify Management
• Regularly correspond with stakeholders via email, telephone, face to face interactions etc.
• Authorize payments within authority limits
• Ensure compliance with company policies and standard operation procedures
• Identify and document system defects

Resolve and reduce complaints 

• Manage complex complaints and difficult customers
• Upskill team to resolve complaints quickly and efficiently
• Minimise follow ups, transfers and delays
• Participate in Satisfaction survey

Reporting on progress

• Use appropriate templates and channels to report progress on a weekly and monthly basis
• Adhere to deadlines and ensuring accuracy and quality

Customer Service

• Manage and Ensure customer service is of high standard
• Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
• Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
• Manage walk-in queries as and when required
• Handle customer inquiries both telephonically and by email
• Provide customers with accurate product and service information in an efficient manner
• Deal with all customers in a professional and empathetic manner
• Address customer satisfaction issues promptly by conducting a root cause analysis and investigating the source of the dissatisfaction

WHAT YOU'LL BRING TO THE TABLE?  

• NQF Level 6: Diploma in a FAIS Recognised Qualification
• COIDA in Practice or Insurance Qualification an advantage
• A legal qualification will be advantageous
• FAIS Regulatory Examination (RE5)
• FAIS Regulatory Examination (RE5) an advantage    
• Minimum of 5 years’ experience within the Insurance/Medical Aid Industry of which 2 years must be at supervisory level
• Knowledge of COID legislation
• Knowledge of Claims processing, approval and payment processes would be advantageous
• Knowledge of all related applications and processes relevant to the position of Team leader
• Good presentation skills and ability to interact with management
• Computer literacy: Advanced MS Word, Excel and Outlook
• Insurance and/or Medical Aid experience would be advantageous

WHAT WILL YOU GET IN RETURN?

We offer great opportunities for personal and professional development in a stable company that’s 127 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

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THE JOB AT A GLANCE

As a Customer Account Executive, you will be responsible for growing the number of lives within the COID business through effective customer engagement and the position of a value proposition to the targeted employers to move to RMA. You will be required to manage and resolve client services queries and visit clients to assist with the submission of the Return on Earnings. The Customer Account Executive will also be responsible for improving customer experience by addressing customer pain points and contributing to high levels of customer satisfaction and loyalty.

WHAT WILL YOU DO?

Growing the COID business lives, handling and resolving service-related queries:

• Provide a value proposition to the employers to enable the transfer and move to RMA.
• Understand the RMA products and promote RMA products and generate leads for RMA Life Sales and Distribution.
• Provide first line product, process and technical support to customers.
• Identify up-selling and cross-selling opportunities through ongoing engagements with customers by explaining product benefits to potential customers
• Follow up on leads and referrals as received from customer engagement
• Ensure adherence to TCF principles and report any transgressions
• Participate in ad hoc assignments as per role requirements

Liaising and maintaining good relationships with all the employers:

• Follow up on customer by engaging with the relevant stakeholders to identify whether all issues have been resolved.
• Set up continuous sessions with the client to build relationship but more importantly to ensure that RMA is providing the right service

Address customer service and satisfaction issues promptly:

• Conduct customer satisfaction surveys, identify and close any gaps identified
• Address customer service and satisfaction issues promptly.
• Conduct a root cause analysis of customer pain points/service failures by analysing trends and identifying areas of improvements
• Ensure customers always receive professional communication regardless of the channel used
• Identify areas of improvement on the system to ensure timeous communication with customers
• Conduct customer satisfaction surveys, capture information received from surveys and share relevant feedback with sales for action
• Assist in projects aimed at transforming customer experience
• Ensure customer contact details are updated on the system

Identify training requirements and organise with the Stakeholder Training Officers:

• Identify training requirements and organise with the Stakeholder Training Officers.

Providing first line product, process and technical support to customers:

• Provide a service to clients, including support on the Return of Earnings, manage and report on the RMA processes including Renewal process, claims process, to ensure customer service and satisfaction, productivity and cost control in comparison with targets set.
• Act as an intermediary by coordinating different RMA service team, including training, claims and any other related services for the benefit of the employers/members.
• Manage the Office honestly, follow high ethical standards, and comply with all Company policies and procedures.
• Deal the appropriate authorities on matters regarding RMA services.
• Carry out all office planning on a regular basis, as issues arise, or in advance of anticipated needs.
• Ensure timely submission of various periodical reports, highlights of the previous month’s reports.
• Ensure proper housekeeping, safety and security of the Rand Mutual Properties.
• To ensure that the Office assets are in a proper condition including ensuring control over movement of same through logbooks and that they are used for official purposes only.
• Communicate effectively with other Departments and Middle Managers by sharing information on effective practices, competitive intelligence, business opportunities and needs

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 6: Diploma in Insurance or a related field
• Short-term insurance / Medical Insurance or Long-term Insurance
• 2-3 years’ experience in insurance sales, service, claims environment.  insurance environment would be preferable).
• Experience in selling and growing business, sales and generation of leads
• Experience in managing customer relationships
• Experience in handling customer complaints
• Experience administering customer and service satisfaction surveys
• Sound knowledge of COID and Life Insurance Products
• Knowledge of insurance value chain
• Knowledge of industry regulations, e.g. POPI, COIDA, TCF, etc.
• Good understanding of the customer experience value chain
• Computer Literate: Particularly experience using excel spreadsheets
• Data interpretation and report writing
• Must be able to travel for business related matters.
• Customer service attitude
• Strong selling abilities
• Multilingual
• Ability to check work accurately, proficient in the use of e-mail and internet, administration skills.
• Administrative skills.
• Good Self-image (Presentable).
• Ability to interface with clients and staff.
• Excellent verbal communication and writing skills.
• Ability to work under pressure and meet deadlines.
• Good presentation skills and ability to interact with middle and senior management

WHAT WILL YOU GET IN RETURN?

We offer great opportunities for personal and professional development in a stable company that’s 128 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.

Turnaround time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days please consider your application unsuccessful.

Closing date: 14 July 2022

Our Commitment to transformation:

In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.

Requirements

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 6: Diploma in Insurance or a related field
• Short-term insurance / Medical Insurance or Long-term Insurance
• 2-3 years’ experience in insurance sales, service, claims environment.  insurance environment would be preferable).
• Experience in selling and growing business, sales and generation of leads
• Experience in managing customer relationships
• Experience in handling customer complaints
• Experience administering customer and service satisfaction surveys
• Sound knowledge of COID and Life Insurance Products
• Knowledge of insurance value chain
• Knowledge of industry regulations, e.g. POPI, COIDA, TCF, etc.
• Good understanding of the customer experience value chain
• Computer Literate: Particularly experience using excel spreadsheets
• Data interpretation and report writing
• Must be able to travel for business related matters.
• Customer service attitude
• Strong selling abilities
• Multilingual
• Ability to check work accurately, proficient in the use of e-mail and internet, administration skills.
• Administrative skills.
• Good Self-image (Presentable).
• Ability to interface with clients and staff.
• Excellent verbal communication and writing skills.
• Ability to work under pressure and meet deadlines.
• Good presentation skills and ability to interact with middle and senior management