Job Description

• Applications are invited for the Claims Quality Assurance Analyst position in Head Office. Reporting to the Chief Medical and Operations Officer, the primary purpose of this role is to ensure that the administration of claims conforms to regulatory requirements from inception to finalisation through early identification and reporting of problem areas to mitigate the risk and ensuring compliance to administrative processes resulting in improved customer service for both external and internal stakeholders.
• The successful candidate will be responsible for conducting interbranch claims audits by assessing potential risks and non-compliance with prescribed rules, procedures and standards of quality.   Training needs based on findings, for preliminary investigation of suspected fraud cases, updating the claims risk register, analysing reports received from the Board of Healthcare Funders to identify the impact on FEM claims as well as policyholder trends in terms of reporting accidents and advising underwriting accordingly are further requirements of the position.
• The minimum requirements of the position are a Matric with a least 3 years’ experience as a supervisor or team leader in a disability claim or related environment. Certification in COIDA Total Quality Management or Auditing are an added advantage. Sound knowledge and understanding of COIDA insurance claims and underwriting operations and related risk management are requirements for the position. Excellent customer focus, the ability to work in a highly pressurised environment, quality orientation, reliability, report writing, and excellent communication skills complete our requirements.
• We have offices regionally in Cape Town, Durban, and Johannesburg. The Head office is based in Rosebank, Johannesburg. Consideration may be given to candidates who can work from any of our regional offices under FEM’s hybrid work program.
• In exchange for the candidate’s successful services, FEM offers a competitive total cost to company remuneration with good benefits.
• Candidates are invited to submit a detailed CV by close of business on 25 July 2024.