Claims Audit Team Leader (12-Month Contract) - Centurion

Introduction Purpose of the role:

The Team leader: Claims Audit is responsible for supervising and coordinating the inspection, verification and quality assurance of backlog claims files and recommend referral for further assessment/escalation in line with the findings.

Duties & Responsibilities Key Performance Areas:

Audit operations coordination

Coordinate daily audit activities and allocate backlog claim files to Officers and Administrative assistants Monitor daily audit volumes, output quality, productivity, stage ageing and turnaround times. Provide first-line technical guidance to the team. Ensure the audit team applies consistent standards when determining whether a file can progress, settle, close or be routed for further action.

 

Workflow and routing management

Ensure claims are routed to the correct stream with clear workplans and outstanding actions. Review routing decisions on complex, unclear or high-risk matters. Monitor time spent at each processing stage or hub and identify bottlenecks. Coordinate handover with referral workstreams Manage productivity. Escalate recurring workflow failures, incorrect routing and dependency delays.

 

Exception Handling

Maintain an exception register for high-risk, disputed, dormant, litigated, prescribed or unclear-routing matters. Resolve first-line technical exceptions and escalate unresolved matters to the Manager: Backlog Audit. Track matters with missing critical information, system discrepancies, unresolved mortality status, disputed merits or incomplete medical/HPCSA records. Coordinate with relevant business units to obtain clarifications and unblock processing. Monitor closure of exceptions and corrective actions.

 

Quality assurance and technical review

 

Conduct sample reviews of audit outputs for completeness and accuracy. Check quality of Home Affairs mortality verification, old/new system reconciliation, prescription expiry recording and payment history review.  Provide coaching and corrective feedback to improve file audit quality.

 

Stakeholder Management

Coordinate day-to-day communication with related working hubs for seamless handover and referrals. Facilitate feedback on handovers, dependencies and routed matters. Support resolution of audit-related queries and information gaps. Represent the audit team in operational discussions where delegated. Maintain professional working relationships and service standards.

 

Reporting

Compile daily, weekly and ad hoc audit reports. Report on audit volumes, productivity, stage status, ageing, product-stream classification, routing outcomes, settlement readiness, closure recommendations and dormant file matters. Analyse trends and recurring issues from audit outcomes. Provide management information to the Manager: Backlog Audit and programme structures. Monitor action plans arising from quality findings or operational issues.

 

People Management

Ensure the motivation, cohesiveness, and alignment of the organisation’s team members. Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of The Company.

 

NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.

Desired Experience & Qualification Minimum Requirements and Experience:

Bachelor’s Degree/ Advanced Diploma in:

Public Administration Business Management Quality Assurance Compliance Legal related qualification. Relevant 5 years’ Quality Assurance experience in: Claims administration related environment of which 2 years must be on the supervisory level in operations management function. Knowledge of Claims management process/ processes and systems: (including handling, verification and validation, investigation, assessment/settlement, litigation, legal costs assessment and settlement). Experience in the public sector would be advantageous. (PFMA) Persons with disabilities (PWD) are encouraged to apply.

Package & Remuneration up to R668,708.00 pa (Based on experience)