Job at Rand Mutual - RMA

THE JOB AT A GLANCE

• The Head for Collection and Membership will be responsible for overseeing the day to day, operational onboarding, and administration of policies for both COID and the RMA Life VAPS products. 
• This incumbent will also be responsible for developing strategies to accelerate the enhancement of the customer experience value chain through the creation of efficient onboarding and policy administration processes for COID and RMA Life VAPS. 
• Furthermore, the incumbent will be accountable for the overall seamless collection of premiums for the Group. The incumbent shall ensure that the relevant standards and company policies and procedures are adhered to.

WHAT WILL YOU DO?

Overall Membership and Collection

• Overall development and execution of membership and collection strategy in line with the budget
• Monitoring the strategy through dashboard reporting
• Ensure that planning takes place in line with standard and that necessary compliance controls are implemented
• Prepare and monitor the functional budget to the COO’s office and review monthly cost centre reports.
• Submit monthly reports to different forums when required.
• Monitor and review recoveries.

Oversee Debtors and Collections

• Review processes followed by the debtor manager to ensure targets are achievable relating to premium collection
• Review and obtain reasons for long outstanding debtors and procedures to be performed to ensure reduced
• Review the reconciliation to confirm billing accuracy and completeness
• Sign term letters for members and refunds
• Review and maintain refunds higher than R25K for AML purposes.

Oversee Membership/Policy Administration function

• Ensure accurate and timeous delivery of invoicing valued at R3bil of COID premium income
• Ensure assessment and enforcement of COID to enhance compliance
• Oversee and contribute to the identification of opportunities to attract and grow the RMA customer segments relationships through improved targeting of best-in-class product/services
• Analyse customer complaints, identify root causes of service issues, develop, and oversee the implementation of recommendations for addressing them
• Oversee the development of initiatives which enhance customer satisfaction.

Staff Management

• Allocate tasks to staff
• Develop KPA’s for staff
• Ensure that staff is trained to carry out duties
• Set goals for own operations team
• Do performance management and address below standard performance
• Daily and weekly supervision of subordinates through informal and formal discussions
• Implement and use the performance management system fully to monitor the performance of subordinates
• Liaise with HR on staff related issues
• Identify training requirements for staff, through effective staff management and assist them in meeting their training requirements, by helping to arrange suitable training for them
• Draft staff work plans and ensure implementation
• Attend relevant industry related committee
• Develop strategic and operational plans for the unit
• Ensure implementation of the plans by supervising staff
• Monitor and review plans on an ongoing basis
• Draft, develop, maintain, and implement policies and procedures in relevant competency
• Maintain relationships with relevant stakeholders including management.

Reporting and participation in various forums/committees and providing compliance support

• Attend Group Operations Exco and Manco
• Adhere to internal controls
• Timeously produce reports for all committees
• Ensure that proposed new products are researched to evaluate financial viability and to forecast performance; Present such reports to top management.
• Ensure compliance with mandatory requirements
• Ensure that all work is performed in terms of required standard and regulation
• Ensure internal audits are completed on time and are successfully coordinated
• Perform any other processes important to identify any fraudulent activities within the Group.

Project Management

• Review the project’s scope high level ensure process is adequate
• Attend meetings when required, provide inputs
• Allocate resources to projects and review outputs
• Plan and manage projects within budget.

WHAT YOU'LL BRING TO THE TABLE?

• Business degree or Finance Qualification
• Post Graduate qualification preferable
• MBA/CA (SA) is advantageous
• FAIS accredited and qualified (RE01 and RE05 Certificates) required
• 10 - 12 years’ experience in financial services industry
• Minium 7 years in a senior management position with at least 5 years’ experience managing a medium to large team
• Knowledge of business policies, processes and procedures, legal compliance
• Background knowledge of financial sector and insurance industry
• Above average IT skills
• Commercial awareness and financial management
• Excellent client relationship management
• Organising and effective management of time to meet commitments.

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THE JOB AT A GLANCE

Reporting to the Team Leader:  Earnings Assessors, the incumbent will be required to liaise with employers to comprehend the salary and benefits reflected on claimants’ earnings, and to enable employers to share accurate information with RMA claim processing staff. The incumbent will also assist the Claims team to ensure that the amounts claimed are calculated correctly and that the percentage allocated for a claim is based on the correct values on the payslip and in line with COIDA limitations.

WHAT WILL YOU DO?

Confirm and verify earnings accurately

• Ensure timeous, correct and accurate calculation of earnings for COIDA and other Non COIDA Products for compensation of benefits being Temporary Total Disablement and Permanent Disablement; Pensions and Fatals on claims received
• Timeously manage workflow requests and notifications on earnings calculations
• Actively liaise with employers on claims earnings submitted procedures
• Conduct investigations on exceptional cases received from Claims staff in relation to earnings captured on processed claims
• Attend workshops to understand RMA Product offerings and operational procedures for such
• Timeous updating of RMA systems with Earnings requirements
• Add comprehensive and accurate notes to ensure that a complete synopsis of the calculations is on the system
• Maintain high standards of work in line with Quality Assurance metrics
• Observe adherence to Standard Operating Procedures
• Proactively identify earning declaration discrepancies and conduct payroll audits to identify non-compliance and\or employer training opportunities
• Provide input to communicate trends with employers using the RMA Newsletter
•  Provide comments to Quality Audit Reviews and timeously respond to Earnings related Quality and Internal Audit Findings
• Process, calculate, understand and interpret monthly, weekly or bi-monthly payrolls as well as do pro-rata calculations (daily, weekly, monthly) in all payroll related earnings
• Understanding the impact of advance or retrospective payments on overall earnings or basic salary as well as the effect of reduced payments or short hours, as well as reimbursements and other ad-hoc payment and their effect or non-effect on employee earnings.

Compliance to legislation, policies and procedures

• Observe adherence to all company policies and procedures throughout the earnings calculations process
• Observe adherence to ethical standards
• Ensure all earnings calculations are done in line with benefits calculations under legislation
• Review and respond to earnings related and Quality Findings.

Reporting

• Use appropriate templates and channels to report progress on a weekly and monthly basis
• Adhere to deadlines and timeously submit various periodical reports Team Leaders.

Customer Service

• Resolve complaints quickly and efficiently
• Minimise follow ups, transfers and delays
• Increase Customer Satisfaction Through Superior Execution

Training Internal and External Stakeholders

• Assist in the development of a training plan and implement in line with both business needs and manage special projects
• Liaise with employers to identify Member training needs, expectations and preferences
• Contribute to the design and development of effective training programmes based on identified employer needs.

Ad hoc projects

• Participate in and complete ad hoc projects and duties as required

WHAT YOU'LL BRING TO THE TABLE?

• Matric with pure Mathematics or Accounting
• NQF Level 6: Diploma in Payroll Administration
• COIDA in Practice or Insurance Qualification an advantage
• FAIS Regulatory Examination (RE5)
• Minimum 5 years’ experience in payroll administration
• Financial audit experience advantageous
• Knowledge of payroll admin processes and basic Finance and Accounting
• Knowledge in submitting COIDA Annual Returns of Earnings
• Knowledge of Income Tax and related legislations and fringe benefits advantageous
• Knowledge of Claims processing, approval and payment processes would be advantageous
• Good presentation skills and ability to interact with management
• Computer literacy: Advanced MS Word, Excel and Outlook
• Insurance experience would be advantageous
• Employee Benefits Knowledge and experience an advantage experience
• Knowledge in Disability Benefits also advantageous
• Knowledge of business policies, processes and procedures, legal compliance.

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THE JOB AT A GLANCE

Reporting to the Team Leader: Clinical Claims Adjudication, the incumbent is responsible for providing support on the effective and efficient adjudication of disease and accident claims in line with COID Act and Non-COID VAPS policies (i.e., updating and reviewing ICD10 codes, pre-authorisation adjudication for out of hospital treatments, case management of all accident claims and claims estimates monitoring and management. The role requires an individual with critical thinking that is able to work independently and triangulate medical information to make claims decision on impairment assessment.

WHAT WILL YOU DO?

Claims processing and adjudication

• Review and update ICD10 codes on all claims in line with relevant protocols and accepted liability. Review medical reports and medical investigation report on the system for acceptance or rejection
• Liaise with medical service providers to submit outstanding medical reports in order to update claims progress status timeously and ensure that claims estimates remain within the acceptable estimates
• Evaluate treatment authorisation to either decline or approve the treatment authorisation request in line with the COIDA gazette. Ensure that the claims are properly case managed based on the treatment protocols that they are receiving versus the injury sustained or disease
• Manage costs associated with the authorization and claims estimates for all open claims
• Assess and update claims close to exceeding their Maximum Medical Improvement (MMI). Evaluate and analyse medical reports linked to claims and ensure claims are updated in accordance with medical reports received
• Communicate (via email and phone call) repudiated claims to claimants and provide reasons/rationale thereof for disease cases
• Adjudicate, Calculate and award  Permanent disability in line with delegation of authority policy, AMA Guide and COID Act instructions
• Adjudicate and recommend permanent disablement to medical advisors if disability impairment is above 10% for confirmation and once confirmation received, process the claim further and refer back to the claim owner
• Liaise and refer disease claims to medical advisors
• Manage high risk and complex  cases
• Close management and monitoring with claims above 500 000K estimated cost per claim
• Support claims team with complex claims queries from external stakeholders.

Attend to queries related to claims under management

• Provide Customer Services aligned to TCF (Treating Customer Fairly)
• Attend to   queries related to claims and escalate to medical advisors where needed.

Medical report writing

• Triangulate and summarise medical information received in order to refer claims to medical advisors and/or Technical Committee for claims decision (extension of MMI beyond 2years or impairment assessment above 10%).

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 7: Degree in Health Sciences (Nursing, Occupational Therapy and Physiotherapy, Clinical Associates
• Post graduate diploma in occupational health advantageous
• 3 – 5 years’ in-hospital clinical/case management/medical aid claims environment experience
• Group Life Insurance experience advantageous
• Occupational Health experience
• Clinical Judgement
• Medical/Financial services
• Insurance sector experience
• RE5 Certificate
• ICD10 knowledge
• MS Office
• COID Act and its instructions
• Occupational Health and Safety Act
• AMA Guide
• Disability Impairment Assessment
• Claims case management
• Stakeholder engagement
• Communication skills (who do they communicate with)
• Knowledge of business policies, processes and procedures, legal compliance.