Claims Audit Manager (12-Month Contract

Claims Audit Manager (12-Month Contract) Centurion Finance / Accounting
Centurion - Gauteng

Claims Audit Manager (12-Month Contract) Centurion

Salary: up to R1, per annum (Based on experience)

Purpose of the role:

The Manager:
Claims Audit is responsible for the efficient management of backlog Claims files initiatives.

Minimum Requirements and

Experience:

• Bachelors Degree/ Advanced Diploma in:
• Public Administration
• Business Management
• Quality Assurance
• Compliance
• Legal related qualification.
• Postgraduate Diploma in:
• Public Administration/ Business Management/ Quality Assurance/ Compliance related qualification will be an added advantage Experience
• Relevant 6-8 years Quality Assurance experience in:
• Claims administration/ Claims Compliance related environment of which 2 (two) years must have been on a management/supervisory level.
• Experience in:
• Claims management process/ processes and systems (including handling, verification and validation, investigation, assessment/settlement, litigation, legal costs assessment and settlement).
• Knowledge of Motor Vehicle Accident legislation.
• PFMA knowledge.

Key Performance Areas:

Policy review and implementation

• Contribute to the development and implementation of departmental policy, procedures, and processes.
• Keep up to date with effective policy and practice execution strategies. Management of Backlog audit initiatives.
• Manage the Audit Hub as the front-door control point for backlog claim status determination, routing, readiness certification, and closure recommendation.
• Ensure mortality verification, claimant validation and outstanding information identification are performed in line with the approved scope.
• Oversee correct product-stream classification for funeral, loss of support, general damages, and loss of earnings matters.
• Ensure claims are routed with clear workplans and next actions to reduce rework and improve throughput.
• Monitor hub performance against productivity, quality, ageing, dependency, and routing requirements.
• Monitor operational, legal, financial, compliance, quality and reputational risks arising from backlog audit activities.
• Recommend process improvements, control enhancements, and corrective action. Quality Assurance
• Establish and monitor quality assurance standards for claim audits, routing decisions, readiness assessments, and closure recommendations.
• Ensure quality reviews test completeness of mortality verification, system reconciliation, prescription recording, payment history, product classification, and status determination.
• Monitor quality trends, incorrect routing, incomplete files, stage status errors, and recurring audit weaknesses.
• Ensure corrective actions are implemented and tracked.

Exception Handling:

• Manage exception handling for complex, dormant, litigated, prescribed, system-discrepant, medical/HPCSA, court order and writ-linked matters.
• Ensure exception registers are maintained and reviewed.
• Direct escalations to Legal, Compliance, work stream hubs or executive structures where required.
• Monitor matters that may expose the Fund to operational, legal, financial, or reputational risk.
• Analyse exception trends and implement process improvements.

Reporting

• Develop and submit operational reports as required.
• Report audit volumes, claim status outcomes, stage ageing, routing, quality, exceptions, closure recommendations, dormant matters, settlement readiness, and legal exposure.
• Ensure performance information is accurate, timely and supported by auditable source data.
• Escalate material risks, bottlenecks, corrective actions, and project dependencies.

Stakeholder Management

• Manage relationships with related workstream hubs and other project stakeholders.
• Facilitate communication between the Audit Hub and receiving work streams.
• Resolve handover, dependency, information, and routing issues.
• Represent the Audit Hub in relevant governance and operational forums.
• Ensure professional engagement with service providers and external stakeholders where required.

People Management

• Ensure the sourcing, development, and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of The Company.
• Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

NB:
Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful

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