Cassava Smartech is looking for a competent Claims Manager to join its short-term insurance and healthcare service team. The main purpose of the role is to provide innovative tactical, operational direction to the development, implementation of claims investigation, analysis, control, and management processes, policies and procedures in line with strategic goals that enhance superior customer experience.

Key Responsibilities

• Claims investigation, analysis, control, and settlement in line with strategic goals, regulation and business rules to ensure agile, effective and efficient management of the claims function.
• Develop, update and monitor adherence to claims controls, standard operating procedures to enhance loss mitigation, risk management, process efficiency, profitability and overall customer service excellence.
• Initiate, implement, monitor and control system related tariff regime, medical aid membership benefit changes and or any other applicable business rules that enhance the claims value chain.
• Create, develop and implement claims digitisation plans that enhance effective management of healthcare service providers and customers as well as align with the overall Group automation vision
• Review system claim reports to ensure correct and consistent system outcomes and access by functional users while facilitating correct claims awards per applicable business, product and service.
• Champion fraud detection, query, general service resolutions, periodic analysis and reporting per product while leading the analysis of claims behaviors, characteristics, experience to enhance innovative and automated solutions.
• Lead service provider relationship management strategies that enhance claim quality, accuracy, change awareness, digitisation and overall claims experience.
• Prepare product, process or system BRDs for claim requirements for review and implementation while driving and timeously resolving Revenue Assurance, Audit and Risk requirement matrices.
• Lead team, personal development and the implementation of people management strategies that enhance engagement and overall achievement of results.
• Oversee claim change processes relating to new systems, system upgrades/ modifications, new products, new markets and new technologies.
• Perform any other relevant duties as may be assigned from time to time.

Qualification, Skills and Experience

• Degree in Risk and Insurance, Actuarial Science or equivalent.
• Insurance Associateship will be an added advantage.
• Affiliation to the Healthcare Funders of Zimbabwe (AHFOZ) essential.
• 6 to 8 years’ experience in operations management in a medical aid or healthcare environment is key, 4 years of which should be in management.
• Strategic, analytical, conceptual, attention to detail and problem solving inclusive of proven client relationship management skills demonstrated by the ability to interact at all levels within and outside of the business.