SPN Integration Lead

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

To lead a team in proactively identifying and mitigating financial risks, preventing losses from Fraud, Waste, and Abuse (FWA), and ensuring the integrity of claims processing for client schemes. , Manage teams responsible for the delivery of claims processes, ensure all relevant policies and procedures are followed, and relevant regulations are adhered to.

Requirements

• 5 - 8 years of experience in risk management, audit, compliance, financial forensic services, or a related field.
• 2 - 3 years people management experience (essential)
• Experience in financial crime compliance or involvement in complex forensic investigations (desirable),
• 5 - 7 years claims experience in the financial services industry (essential)

Duties & Responsibilities

Internal process

• Ensure all required reporting is completed accurately on a daily, weekly and monthly basis.
• Manage daily workflow and lead effective resource planning to ensure business continuity.
• Manage the implementation of standard operating procedures, quality and service standards.Monitor and evaluate claims processes for quality and effectiveness and adjust as required.
• Implement and monitor the application of good governance principles, Treat Customers Fairly (TCF) principles and legislative compliance.
• Review performance targets in line with business objectives and realities to ensure optimal performance is maintained.
• Create, implement and ensure compliance to the relevant Service Level Agreements (SLAs).
• Drive continuous improvement initatives to drive efficiencies and improve client experience.
• Drive and monitor team up-skilling to address product knowledge gaps.Manage escalation process to resolution, identify opportunities for improvement and resolve any issues.
• Identify system inefficiencies and drive the resolution process with other internal stakeholders.
• Establish productive operational relationships with key stakeholders in the various channels and administrative teams.

Client

• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
• Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.
• Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.
• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall client targets.
• Provide authoritative, expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Contribute to the process of negotiating objective and realistic service level agreements, monitor appropriateness and recommend adjustments.
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

People

• Create a positive work climate and culture to energise employees, give meaning to work, minimise work disruption and maximise employee productivity.
• Demonstrate exemplary leadership behaviour, through personal involvement, commitment and dedication in support of organisational values.
• Select and recruit suitably qualified talent in line with Employment Equity principles and Momentum Metropolitan values.
• Drive a culture that guides and directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
• Enable a learning and growth culture whereby information regarding successes, issues, trends and ideas are actively shared between team members.
• Execute effective workforce planning practices to ensure that staffing requirements are accurately forecasted.Identify employee growth and development needs and schedule interventions to enable ongoing development, training and personal growth.
• Effectively manage performance within the team in order to ensure business objectives are achieved.
• Encourage innovation, change agility and collaboration within the team.

Finance

• Contribute to continuous improvement efforts by the identification of opportunities, management of risk, cost reduction, improvement on the quality of claims decisions, service and systems enhancement.
• Implement risk management, governance and compliance policies in own practice area, to identify and manage governance and risk exposure liability.
• Investigate reported wilful acts of non-compliance to organisation policy and practice and report on findings.,

Process

• Develop a comprehensive understanding of the internal environment in line with business requirements to inform decision-making and strategy.
• Perform prepayment analytics and utilise other Fraud, Waste, and Abuse (FWA) analytical tools to identify outlier behaviour, enabling early detection of irregular claims.
• Refine prepayment tools to enhance sensitivity and accuracy in detecting irregular claims behaviour, improving the effectiveness of fraud prevention measures.
• Review case reports or summaries prepared by direct reports for timely intervention, mitigating future financial losses due to detected fraud/abuse and ensuring client protection.Manage and support a team of Fraud, Waste, and Abuse (FWA) Forensic Investigators, fostering collaboration and maximising their performance.
• Improve turnaround times of investigations, emphasising claims risk management within the business, optimising efficiency and minimising potential losses.
• Ensure timely application of policies, interventions, and sanctions, meeting regulatory requirements, Scheme Service Level Agreements (SLAs), and Standard Operating Procedures (SOPs) in claims risk management, ensuring compliance and effective risk mitigation.
• Audit information received from providers, draw appropriate conclusions on validity, and establish the extent to which findings are proven, ensuring accurate and reliable assessment of claims.
• Quantify incurred losses and contribute to the compilation of a comprehensive report, providing insights on financial impact and risk exposure.
• Recommend necessary actions, including case closure or presenting findings to the client forum for decision-making or implementing punitive sanctions when required, enabling appropriate measures to be taken against fraudulent activities.
• Manage documentation, records, investigation notes, and other evidence to maintain accurate and accessible records, supporting investigations and regulatory requirements.
• Participate in legal processes where necessary and testify to investigation findings if required, providing expert insights in legal proceedings.
• Stay updated on relevant legislation, regulations, and policies within the finance/insurance industry, ensuring compliance and adaptability to changing requirements..
• Contribute to the development of fraud prevention policies, strategies, plans, and related documents, enhancing the organisations ability to detect and prevent fraud.

Competencies

Talent