Job Description

Job Summary Purpose of the job Responsible for the reconciliation of the monthly membership data vs. premiums due and received. Responsible for initial update in respect of client reconciliation Responsible for the submission of all risk benefit claims received and monitoring the process until claims are paid Purpose of the Job Responsible for the reconciliation of the monthly membership data vs. premiums due and received. Responsible for initial update in respect of client reconciliation Responsible for the submission of all risk benefit claims received and monitoring the process until claims are paid Key Relationships External Insurance Companies / Underwriter Consultants Internal and External Brokers Internal Staff Key Responsibilities Data: On a monthly basis ensure premiums and data are received for each scheme Ensure the correct updating of the scheme membership data Reconcile the monthly membership data (as updated) vs premiums received per scheme Ensure strict adherence to the documented processes Update membership onto relevant administration platform and ensure this balances to the client premium reconciliation and data Reconciliations: Prepare and provide premium recons to clients monthly analysing under or over payments Perform credit control checks and follow up for over and underpayments Follow PPR15 processes by informing clients of non-payment within specified deadline Claims: Action all claims timeously Ensure correct execution of all claims in terms of documented processes Maintain updated claims workflow systems Ensure data records are always correct with regards to PHI claimants Medicals On a monthly basis identify members whose insured benefits are in excess of the Medical Free Cover Limit on each scheme Process medical requests immediately in terms of set guidelines Ensure data records are always correct with regards to members whose insured benefits are in excess of the Medical Free Cover Limit on each scheme Maintain updated medicals workflow system General Attend to all other client requests (benefit statements, conversion options, monthly billings etc.) Ensure the divisional renewals team is provided with information required to do the annual renewals on the schemes Assist (as and when required) the divisional finance team to ensure that the client reconciliations of premiums due and received are updated correctly Education/Qualification requirements Matric Relevant business qualification or equivalent experience At least 3 years of relevant working experience Skills and Knowledge requirements Skills Highly Computer literate and thorough knowledge of Excel and its application Analytically Inclined Accounting Inclined Strong Administrative skills Problem solving ability Good Communication skills Professional Independence and assertiveness Knowledge Thorough knowledge of Risk Benefits & Employee Benefit Industry Extensive work experience and knowledge linked to the Risk Benefit Industry Understanding of the Financial Services Industry Key Attributes Integrity: Being ethical and truthful, maintaining good governance practices, and not misrepresenting or withholding information to which stakeholders are entitled. Interdependence: The achievement of goals is based on the interrelationship of all the components of the service delivery chain. Client focus: Actions derived from stakeholder needs. Organisational Awareness: Understands business plan goals. Teamwork: Working cooperatively and productively with others to achieve results. Impact and Influence: Persuading, convincing or influencing. Fairness: Consistency in dealing with others Professional Work Ethic: Always working with diligence, competence, confidentiality, and reliability. Self-managed: able to work without constant supervision Key Competencies Ability to interact with persons in junior and senior positions; Ability to work under pressure; Be a self driven Individual, dynamic, self confident, outgoing and a self-starter with client focussed attitude;

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