• Audit claims in line with the insurance policy definitions and exclusions. • Assess all claims information and forward all incomplete documentation to the relevant stakeholder for resolution. • Resolve escalated claim queries and ensure queries are processed in a timeously manner. • Monitor and manage the adherence to the service level agreements for authorizations • Be responsible for, coaching and guiding the claims team in claims management processes and procedures. • Ensure that the necessary risk management controls are in place • Assess, quality control and authorize the payment of claims • Answer escalated claims related queries telephonically and in writing • Active participation and management of the implementation of projects • Liaise with various external and internal stakeholders • Manage day-to-day assignments by adhering to the following: • Ensure the understanding of daily assigned tasks • Ensure the understanding of the methodologies and procedures to complete the assigned tasks and achieving set targets. • Ensure the understanding of tracking of own results, giving and receiving feedback on problems experienced during the completion of the tasks • Management of all work processes within the team to ensure efficiencies, adherence to SLA and the compliance of all processes • Ensure that problems are identified and resolved timeously • Be responsible for the adherence to the standardized quality objectives

I assist people to create and protect wealth , to achieve their financial goals.• Conducting in-depth reviews of clients' financial circumstances, current provision and future aims; • Analyzing information and preparing plans best suited to individual clients' requirements • Completing risk analyses; researching the marketplace and providing clients with information on new and existing products and services • Designing financial strategies; assisting clients to make informed decisions; researching information from various sources, including providers of financial products • Reviewing and responding to clients changing needs and financial circumstances • Promoting and selling financial products to meet given or negotiated sales targets • Ensuring clients documents are according to FICA standards (fit and proper), • Capturing of Client’s details and processing of application. • Reviewing of Policy within 6 months to 1 year period.

• Administration of the Funds of Employers and Employees in the Steel and Engineering Industries • Processing of Benefit claims • Corresponding with clients and members via email and telephone • Administration of withdrawal, death out of service, retrenchment and retirement claims and transferring of benefits from one fund to the other. • Assessment of documents in line with company standards and procedures • Completing and submitting necessary statistical reports • Attending to Customer queries relating to benefits and general enquirer in terms of the pension fund act. • Preparing claims for the payment of benefits on the workflow, Alex and Mainframe systems. • Calculating benefits to be paid out to the beneficiary. • Ensuring that all member’s personal information is kept safe, no third parties allowed to access any information.

• Data Capturing • Claims Management, 100 new claims per month • Management of minor injury claims • Follow up on rejected medical invoices due to outstanding claim forms • Processing payment of Medical invoices • Ensure all scanned documents have been indexed correctly • Management of Notifications • Follow up on notifications where full claims have as yet not been received • Management of Medical Reports • Capture and/or accept medical reports within 7 days of receipt • Updating of ICD10 codes • Management of death claims • Management of Temporary Total Disablement claims • Acceptance and/or capturing and payment of Temporary Total Disablement claims • Ensure that all Temporary Total Disablement claims are supported by a medical report • Management of the Timeous Finalization of Claims • Calculation of PD assessment – workflow to Clinical Claims Adjudicators for electronic sign off • Internal Audit