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PURPOSE OF ROLE

• To receive and perform quality assurance on documents and assessment of claims for legitimacy based on the specialized requirements of the role.
• To initiate all new claims received on the operating system used by Salt Employee Benefits
• To follow up on behalf of members on all outstanding claim payments
• To deal with member queries and advise members on fund benefit structure and benefits
• To act as a liaison between the members of the Fund and Fund’s other service providers (funeral benefit administrator, Section 37C Investigators, Trust Fund Administrators, Tracers) in receiving claims and ensuring that they are processed timeously.

WALK IN MEMBERS

• Receive members and help them with submission of claim.
  • First ensure that the member is a member of the Fund
  • Ensure that the member is not still employed in the industry
  • Check that the contributions are up to date
  • Check that all claim documents are available:
    • Claim documents are completed, signed and stamped by both employer and member
    • Copy of ID is available and clear
    • Copy of bank statement is available and clear
    • Valid Tax number for the member

• • Advise member if there are any discrepancies regarding the membership or any of the above.
  • Help member to understand what the member needs to do.

• Attend to members and beneficiaries who are submitting and following up on their claims (withdrawal, funeral, disability, death, unclaimed benefits, retirement, trust fund)
  • Ensure that the member’s claim has the necessary documentation and attachments according to type of claim.
  • Escalate claims that are outside the service level agreement.
  • Advise member of any outstanding documentation or what will affect the delay of the claim.
• Advise members who come to enquire about their membership on their status
• Where a member has shown proof that they were employed and the employer has not paid, refer to the relevant CLO/MCLO for further investigation.
• Provide members with benefit statements, contribution history and quotations where available.
• Educate members on benefits of the fund and process.
• Provide a daily report to the manager for consideration and review.

REPORTING AND ADMIN

• Submit daily and weekly reports.
• All claims and documents to be uploaded and indexed on Everest/EPIC system used by Salt

RELATIONSHIP MANAGEMENT

• Strictly adhere to the rules and policies of the Fund, legislation, administration procedures and service level agreements.
• Maintain and improve quality results by adhering to standards and guidelines; recommend improved procedures.
• Attend internal and external training required.

TIME MANAGEMENT

• Excellent time management.
• Flexible and ability to work under pressure and multitask.

KPI

1. No quality assurance failures on new claims submitted
2. Feedback from members, colleagues and employers on employee performance
3. All claims initiated on EPIC will have complete documents and ready for processing
4. Unpaid claims outside of SLA timeframes that have been escalated for payments
5. Unattended claims with proof of escalations
6. Identified discrepancies between work done by yourself and your colleagues.
7. Members assisted are correctly captured and reported.
8. Timeous reports on employer engagements.
9. Reports provided daily without any errors.

COMPETENCIES REQUIRED

• Matric
• Basic Excel skills
• Communication (Written and Verbal)
• English (Business writing and email etiquette)
• Stakeholder management (CRM)
• Industry knowledge and at least 2 years Industry experience
• Accuracy and attention to detail
• Judgement and Decision Making
• Working under pressure And Deadline driven
• Organizational skills / Planning and prioritizing
• Interpersonal skills
• Settings goals
• Cross team collaboration
• Innovation
• Management of time
• Customer service

QUALIFICATIONS

• Matric or Recognition of Prior Learning