Reference Number HOL230428-1
Job Title Claims Quality Assurance Specialist
Business Unit Hollard Insure
Department Claims
Job Family Operations - incuding Claims, Policy Servicing, Underwriting and Retentions
Job Type Classification Permanent
Reporting To Claims Quality Assurance & Quality Control Manager
Number of Positions 1
Location - Town / City Parktown
Location - Province Gauteng
Location - Country South Africa
Job Advert Summary
An exciting new Claims Quality Assurance Specialist opportunity has just become available in our Insure, Operations (Claims Area).
Role Objectives
Create operational efficiencies in utilisation of management information systems, data management and reporting. Develop statistical information reporting formats and dashboards. Builds and enhances data. Create new processes and templates for data collection and storage. Required to translate complex data and/or instructions into meaningful outcomes. Required to interpret data and provide meaningful recommendations to the business. Collate statistical information. Integrate data into daily, weekly and monthly reports.
Key Responsibilities
- Conduct quality audits of service calls, business processes and transactions as well as the management operation systems.
- Review claims in respect of adherence to processes and decision making. Identify and recommend solutions to possible risks within the claims processes and or decision making.
- Perform complex data analysis in support of ad-hoc requests. Collecting, analysing and interpreting data
- Effective management of data. Use data mining tools to identify patterns in the data
- Enhance existing databases. Information Administration
- Collate statistical information from various sources / systems / databases
- Develop statistical information, reporting formats and dashboards development.
- Integrates data into daily, weekly and monthly reports.
- Automate data management and reporting utilising existing systems, e.g. Excel, Powerpoint, SQL, Purple Heron, TIA Grail, QlikView, SPM etc. Identify risks to the company and escalate accordingly
- Dealing with client requests in a competent, efficient and professional manner
- Support effective teamwork. Quality control checks
- Relationship management: Working with and support the claims teams in the regional offices as well as managing relationships with Suppliers and Service Providers
- Continuous Process Improvement: Ensure full compliance to all processes, policies and procedures and identify areas for improvement.
- Employee Growth: Take responsibility for your own career growth and have regular discussions with the relevant role players. Conduct quality audits of service calls, business processes and transactions as well as the management operation systems.
- Participate in special assignments on various project teams as determined by Management.
- Monitor business units to ensure service level agreements both internally are being met and managed, and give the necessary feedback in terms of process gaps identified.
- Assist in the development of quality control measurements, audit sheets and process changes in line with business requirements.
- Review and analyse data and documentation and business processes, and identify opportunities through trends and analysis for continuous improvements and prepare reports to communicate to business units. Direct the investigation and resolution of customer complaints through the business units to ensure full response and continuous control over service, and product delivery. Maintain working knowledge of Standard Operating Procedures and Processes, along with performance goals and objectives and apply such knowledge to evaluation and analysis of service activities.
- Assist with identifying required coaching and or training for business units to ensure continuous improvement and full adherence to business process. Actively live the Hollard Insure values
- Minimum 5 Years team leader experience in Commercial and Personal lines claim environment
- Computer experience within a proficiency in Microsoft Office, particularly MIS Excel and SQL, Powerpoint.
- SPM, Indlela, Purple Heron, Qlikview is an advantage
- Advanced Excel and sound knowledge of various system
- Matric/Grade 12
- Insurance qualification or equivalent/Diploma
- RE5/FAIS Compliant
