Jobs at Rand Mutual - RMA

THE JOB AT A GLANCE

Reporting to the Head: HRBP, the Senior Human Resources Business Partner (HRBP) will be responsible for managing and translating the people agenda for the assigned division/s. The Senior HRBP will be required to deliver a full suite of HR functions across the HR life cycle in their assigned divisions. The incumbent will also act as a trusted advisor and strategic partner to the executive and management teams in the assigned division while ensuring that the human capital capability is effectively enabled. 

WHAT WILL YOU DO?

Strategic HR

• Effectively translate the HR strategy across the HR value chain and ensure organisational alignment through tactical plans
• Support the Head: HRBP with designing, developing and implementing innovative, value-added solutions to align with business objectives
• Deliver a full suite of HR functions across HR life cycle by assessing business needs and engaging with HR Centres of Excellence to identify appropriate solutions to help steer business in the right direction

Organisational Development 

• Execute recruitment plans in line with the workforce plan and defined budget and participate in candidate interviews and decision-making processes.
• Manage the end-to-end Performance management process including performance contracting, performance reviews, development of PDPs while ensuring that information is submitted timeously
• Provide expert guide to line management on performance management processes, policies and practices
• Manage the end-to-end Talent management processes including proactively identifying key talent and ensuring that talent management strategies are implemented e.g. career discussions with manager, career development plan with clear objectives and goals, provision of mentors etc.
• Manage the end-to-end succession management process for the assigned division, including succession reviews, ensuring adequate bench strengths, conducting skills gap analyses)
• Gain an in-depth knowledge of the business unit’s talent, to actively identify performance gaps, skill gaps, leadership gaps and decreased employee engagement

Ensure Sustainable Employee Engagement

• Facilitate the implementation of engagement surveys
• Engage with management to interpret the results of engagement surveys and advise management on how to improve engagement and sustain engagement levels
• Provide recommendations and implement solutions to motivate, develop and retain employees

Provide Ongoing HR Business Partnering to Management

• Proactively partner with clients to identify strategic issues, workforce planning or organisational design challenges and provide advice and expertise to help develop creative solutions in collaboration with the relevant Centres of Excellence
• Provide expert guidance and general HR thought leadership to management on all HR process across the employee life cycle
• Consult & collaborate with management teams to identify HR initiatives that facilitate the enablement of their teams
• Actively engage with management across all levels to gain an in depth understanding of the business objectives and processes, to ensure that the people related agenda will lend to organisational efficiency, improved people management skills, and a shorter response time for HR.

HR Operations Management

• Provide guidance and coaching to line managers and employees on ER related issues by assisting them with correctly interpreting legislation, policies and procedures
• Initiate and participate in disciplinary hearings as and when required
• Assist line managers with implementing fair procedures when dealing with misconduct, poor performance and incapacity and ensure fairness and consistency in application across assigned divisions
• Provide advice and guidance and management on all HC processes and procedures

Reporting 

• Analyse trends and metrics to identify problems in people management areas such as absenteeism, disciplinaries and performance management
• Provide accurate and professional reports and presentations for the management team if and when required.

Team Coaching and Support

• Provide support and coaching to HRBPs through frequent informal and formal discussions.

Requirements

WHAT YOU'LL BRING TO THE TABLE?

• Knowledge of business policies, processes and procedures, legal compliance
• NQF Level 7: Bachelor’s Degree in Human Resources or related field
• NQF Level 8: Honours Degree in Human Resources (preferable) 
• 5 – 8 years’ human resource business partnering or HR Generalist within a financial services/insurance industry (preferred)
• SABPP Registration (advantageous)
• Excellent working knowledge of the South African Labour Law
• Solid experience in and full understanding of the end-to-end employee life cycle
• Ability to engage at all levels
• Ability to operate strategically as well as operationally
  • Experience in the medical aid / health management / insurance/IT industry is advantageous

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THE JOB AT A GLANCE

As the Claims Administrator, you will be reporting to the Team Leader: Claims Administrator. You will be responsible for capturing of claims, following up on outstanding documents from relevant stakeholders and indexing of documents. You will also be responsible for keeping stakeholders informed and updated via various channels i.e. email, telephone, SMS etc. throughout the various stages of the claims processing cycle. In addition, you will also be responsible for the day-to-day operations of the branch premises where applicable, manage queries from walk-in clients and channel stakeholder queries according to the Service Level Agreement.

WHAT WILL YOU DO?

Claims Administration

• Acknowledgement of claims upfront, distinguish between minor and serious injuries and products
• Communicate and articulate the claims process and requirements to the claimants and employers, as pre-defined processes
• Refer/channel claims to relevant departments
• Gather information, send follow-ups and reminders on outstanding claims documents
• Prepare, scan, and index internal and external documents i.e. medical reports, invoices, investigation reports, images, received from clients according to company procedures and Service Level Agreement
• Organise scanned documents on the local network
• Identify and edit/correct the legibility of scanned documents
• Analyse documents received to produce the appropriate shades and best resolution in scanned reproductions
• Ensure that there are no duplicate documents uploaded on the system on an ongoing basis
• Assist in checking the eligibility and validity of the Employer
• Perform any other ad hoc duties as assigned
• Provide backup services for team members
• Capture Temporary Total Disablement for payment.

Query resolution

• Manage and resolve customer enquiries
• Identify and escalate priority issues
• Act as backup for the Contact Centre for email\calls overflow and during system downtime.

Branch/Team Administration

• Carry out all office planning on a regular basis, as issues arise, or in advance of anticipated needs
• Continuously ensure proper housekeeping, safety and security of the Rand Mutual Properties
• Compiling records of office activities i.e. keep an electronic and manual register of walk in clients
• Order and maintain relevant office supplies
• Arrange team meetings and distribute minutes.

Customer Service

• Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff, and 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 in line with the RMA Service Catalogue
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Provide customers with accurate product and service information in an efficient manner
• Update existing customer personal information
• Deal with all customers in a professional and empathetic manner
• Assist stakeholders with using the correct processes for logging their queries.

Reporting on progress

• Using appropriate templates and channels to report progress as and when required.

Requirements

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 5 Higher Certificates and Advanced National (vocational) Certificate in business administration or commerce
• 2-3 years clerical, scanning and indexing experience required
• Data-entry experience and good typing skills
• Additional insurance related qualifications or training will be advantageous
• Knowledge of administrative and clerical procedures
• Computer literate – Intermediate MS Office Suite
• Knowledge of customer service principles and practice
• Good Administrative skills
• Deadline driven
• Additional insurance related qualifications or training will be advantageous
• Insurance and/or Medical Aid experience
• Knowledge of Claims processing, approval.

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THE JOB AT A GLANCE

As the Team Leader - Clinical Claims Adjudicator, you will be reporting to the Clinical Claims Manager, you will be responsible for leading and supervising the effective and efficient claims adjudication of COIDA and Non-COID i.e., ICD10 codes, Authorisation of treatment, TTD (Total Temporary Disability), claims estimates, Management of Claims MMI (Maximum Medical Improvement), PD (Percentage Disability) calculations and recommend Whole Person Impairment percentage, etc.

WHAT WILL YOU DO?

Team coaching and performance management

• Supervise the Clinical Claims Adjudication Team who is responsible for the Medical Management of claims aligned to treatment protocols and COIDA limits and generate Authorisation of treatment plans and devices
• Oversee the adjudication of valid disease claims in line with COIDA instructions
• Identify training needs for direct reports and maps development plans accordingly
• Coach and mentor direct reports
• Manage performance of staff (high and poor performance). Allocate, monitor and track achievement of performance targets for the team.

Reporting and project management

• Use appropriate templates and channels to report progress on a weekly and monthly basis
• Adhere to deadlines and ensure accuracy and quality of information
• Ensure that daily exceptions reports are actioned promptly
• Continuously review operations processes.

Organizing and workload management

• Ensure that work is promptly allocated to available staff in a balanced manner
• Ensure that all inter-departmental service levels are adhered to by staff
• Continuously monitor that daily targets of staff are met
• Conduct quality checks of the claims adjudicated by the team
• Manage the costs associated with the authorization and claims Estimates.

Communication and stakeholder management

• Provide Customer Service aligned to TCF
• Resolve queries which are escalated related to claims under their team’s control
• Engage relevant internal and external stakeholders to ensure understanding of COID claims processes
• Consistently identify and engage with relevant stakeholder in alignment with strategic goals.

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 7: Degree in Health Sciences (Nursing, Occupational Therapy and Physiotherapy)
• Experience and/or qualification in Occupational Health
• FSCA Regulatory Examination (RE5) Certificate
• FSCA Regulatory Examination (RE1) Certificate (advantageous)
• Registration with relevant Professional body (advantageous)
• Post-graduation certification/qualification in management (advantageous)
• 5 years' experience in medical aid claims environment or group life claims environment
• 2 to 3 years supervisory/team management experience
• Treatment Pre-authorization experience
• Occupational Health experience
• Whole person impairment Assessment experience
• COIDA experience (Insurance experience)
• Claims management experience.