Manager: Claims Processing


Gauteng, South Africa


Sep 29

Manage the Benefits Investigation and claims processing function, ensuring the provision of professional support services to the surviving dependants/beneficiaries (for informed allocation of benefits) to the correct beneficiaries in compliance with the Fund rules, Section 37C of the Pension Funds Act and related Acts. Ensure the timeous and accurate payment of benefits, manage issues associated with claims and benefit administration Manage internal departmental functions and processes- Develop and implement plans for the section that support Pension Administration and EPPFs objectives, ensuring optimisation of current business and workflow processes. oall benefit processing activities in accordance with the benefits as defined in the rules of the Fund and applicable legislation. oUnclaimed benefits and Evidence of Survival reviews, tracing and verification oFund valuation and all audits- Provide interpretation advice on the application of the Rules of Fund.- Ensure that audit controls are in place and audit requests are followed up.- Participate on the defined Committees (Benefits Committee (BC), Medical Panel (MP), Management Benefits Committee (MBC)) and take decisions based on formal documentation.- Implement controls and work plans, these may include allocating field trips, establishment of deadlines; control registers and implementation of databases for both ill health administration & social work case registers.- Manage the administration system, checking that accurate record keeping and query management is adhered to.- Manage the query and issues log for the department, monitoring turnaround times and responses to queries.- Compile weekly/monthly statistical reports on the departmental activities and performance.- Compile annual departmental statistical summary of departmental activities.Project Management - Participate in the Funds overall projects as required with continuous focus on Business Processes, system enhancements, omni channel business insight, contributing expertise to enable project objectives to be met.- Draft reports as part of the project deliverables.Provide input to the strategic management of the section - Contribute ideas for improved service delivery at Management meetings.- Compile comprehensive business reports for this function, highlighting successes and risks in terms of achieving the sections objectives.- Keep abreast with changes in relevant guidelines and other legislation, to make recommendations where policies and procedures need to be amended.- Develop, enhance and implement processes and procedures that are relevant to the section and enhance service delivery.- Collaborate with internal and external stakeholders to implement new systems and processes, enabling integration to other areas.Oversee Section 37C dependency investigations on death benefits allocations- Manage investigations on death benefit cases confirming dependency with recommended benefits allocation percentages for approval by Benefits Committee.- Monitor that outstanding banking details for payment of approved death benefits are followed up, and confirmed.- Verify that death benefits allocation reports produced are legally compliant with recommendations and reflect minimal errors.- Manage multi-disciplinary case reviews on benefits allocations with Legal Department- Provide a Benefits Allocation Checklist to ensure fair and equitable allocation of death benefits- Monitor that reports are written in required format and settings and information on reports is accurate and logically concluded.- Co-ordinate submission of death benefits allocation reports to management within agreed timelines for before Benefits Committee (BC) meeting for approval.- Participate in Benefits Committee meetings, contributing expertise in order to facilitate decision making.- Oversee enquiries, cooperate and provide information on legal complaints.Oversee the provision of social services to guardian cases; implementation of Benefits Committee & Medical Panel decisions and requests / referrals for case investigations and social advice from other internal departments- Implementation of decisions, requests and referred cases, with reports and recommendations being submitted to BC, MP& BP or other internal departments.- Ensure compliance with Fund rules and legislation to suspension, addition, termination and reinstatement of beneficiaries (widows and minor children) in compliance.- Monitor guardian changes, Trust advances and payments- Oversee the accurate payment of benefits to the correct beneficiaries.- Monitor the use of childrens instalment lump sum accounts and pension benefits to reduce the number of unnecessary requests for advanced payment.- Monitor customer and stakeholder enquiries are accurately and sensitively resolved or escalated to the appropriate level.People Leadership - Manage planning of resource requirements, ensure sufficient capable resources are in place to meet service delivery demands, maintaining the effective and efficient capability of the department.- Build a high performing team where the best people are deployed in the right roles and deliver against strategy. - Ensure that all employees are motivated, developed.- Manage employees performance and ensure that their individual and collective performance is of the required standard.- Implement and maintain an effective system of internal controls and delegations of authority for the department, to ensure that accountability for decisions made.- Inspires, aligns and engages employees around the vision and strategy of the Fund, maximising employee engagement and willingness to invest discretionary effort. Financial Management - Forecast annual capital and operational expenses for the section in line with corporate policy.- Manage costs against approved budget.- Investigate methods to contain / reduce costs.Corporate Governance- Ensure compliance to procedures and relevant legislation- Provide detailed, accurate information for internal and external audit purposes within specified deadlines.- Action audit issues identified within time frames indicated.- Implement controls within the section which minimize potential risk to stakeholders.- Compile accurate financial statements, reflecting the status of the section.- Maintain sound relationships with key stakeholders within EPPF.- Participate in management forums within EPPF, contributing expertise to enable sound decision making.Contribute to the team- Provide assistance to internal and external stakeholders, as required.- Assist with follow up on issues identified within the section.- Liaise with Eskom employer HR, other Pension Administration staff and Accounts on member and pensioner benefits investigation issues.- Participate in EPPFs projects, contributing knowledge of benefits investigation processes and requirements.

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