At Zimele Technologies, we specializein delivering comprehensive SAP ERP and Utilities (IS-U) solutions tailored tomeet the diverse needs of organizations. Our expertise lies in maximizing thevalue derived from Information and Communication Technology (ICT) investments,ensuring compliance with government regulations, and providing prebuilt,internationally best-practice-aligned ERP systems. Our SAP-based solutionfacilitates high-quality service delivery, offering benefits such as improvedcustomer relationship management, efficient service delivery, accurate billing,streamlined address and regional structure management, enhanced customer datamanagement, optimized revenue collection, and improved financial management.Our Meter-to-Cash solutions prioritize fair billing and invoicing processes,minimizing rates and reducing outstanding receivables through highly flexible,automated processes. Leveraging our Meter Data Management System (MDMS) and Advanced Meter Infrastructure (AMI) services, we enable organizations toharness smart meter data for billing, troubleshooting, and energy usageanalysis. As an accredited SAP partner, our AMI solutions empower seamlessexecution of meter-to-cash processes globally, providing intelligent meteringsolutions built on the SAP platform for easy integration, ultimately improvingrevenue collection, reducing operating costs, and enhancing customersatisfaction.
Job Summary
The SAP Claims ManagementConsultant is responsible for the implementation, configuration, and ongoingsupport of the SAP Claims Management (FS-CM) module. This role involvescollaborating closely with business stakeholders across claims, underwriting, andcustomer service functions to understand claims processing and settlementrequirements and translating these needs into effective SAP Claims Managementsolutions integrated with SAP S/4HANA and FS-CD (Collections andDisbursements). The Consultant will ensure accurate and timely claimsregistration, reserving, adjudication, and payment processing, while supportingfraud detection, recovery, and regulatory compliance requirements across the claim’slifecycle.
Key Responsibilities
• Implementation and Configuration • Conductworkshops to gather and understand Claims Management requirements. • Configure and support the following Claims Management processes:
1. Claims Registration and Processing • Maintain and support claims workflows, claim activities, claim transaction types, and status profile management. • Demonstrate strong knowledge of IDoc processing, including: o IDoc monitoring and troubleshooting o Reprocessing of failed IDocs o Error analysis and resolution o Interface support and monitoring • Knowledgeable of Key Business Partner Concepts o Understand and configure different BP roles throughout the insurance lifecycle. o BP relationship to payments and recoveries. o Configuration of Business Partner, Duplicate checks, Contract Account, Insurance Object, Benefit Types, Reserves, Payments, Recoveries, and FS-CD integration • Demonstrate comprehensive knowledge of Workers' Compensation business processes, including Compensation eligibility determination, Injury assessment processes, Medical assessmentprocedures and Benefit entitlement validation. • Configure and support Workers' Compensation benefit calculations for Return-to-Work Benefits, Permanent Disability Benefits, Temporary Total Disability Benefits, Temporary Partial Disability Benefits, Death Benefits, Medical Benefits, Funeral Benefits, Dependants' Benefits, and Claim Closure Processes. • Configure and support subrogation processes, recovery management, salvage processing, refund processing, and interest calculations where third-party liability exists, along with correspondence and document management functionality.
2. Coverage Validation and Policy Verification • Validation of policy coverage. • Verification of policy terms, conditions, and eligibility requirements.
3. Reserve Management • Creation and maintenance ofclaim reserves. • Estimation of futureliabilities. • Monitoring and management of claims costs. • Configuration of reserve rulesand reserve adjustment processes. • Support accurate financia lreporting through effective reserve management.
4. Claim Adjudication and Payment Processing • Configure claim assessment and adjudication workflows. • Support benefit determination and payment authorisation procedures. • Manage approvals and decision-point workflows.
5. Disbursement Processing • Ensure seamless integrationmnbetween SAP Claims Management, SAP FS-CD, and SAP Finance. • Support claims payment processing, recovery transactions, and financial reconciliation activities. • Configure and support reservesetting, adjustment workflows, and claim adjudication processes in alignment with business rules and policy requirements. 6. Fraud Detection and Compliance • Configure fraud detectionindicators and business rules using BRFplus. • Implement and support automatedfraud referral and investigation workflows. • Ensure compliance with regulatory, governance, audit, and risk management requirements. • Support monitoring and reporting activities related to claims fraud and compliance controls.
• Support and Troubleshooting Ø Provideongoing support and troubleshooting for SAP Claims Management by performing thefollowing activities: o Provide ongoing functional support and maintenance for SAP Claims Management to ensuresystem stability and business continuity. o Investigate,analyse, and resolve application defects, configuration issues, interfacefailures, and process-related incidents in accordance with agreed servicelevels. o Perform root cause analysis on recurring incidents and implement corrective actions tominimise business disruption and improve system performance. o Collaborate with SAP technical teams, SAP Fiori developers, Basis, integration specialists,and other functional consultants to resolve cross-functional integration,interface, and performance issues. o Monitor and support SAP Claims Management interfaces, including IDoc processing, erroranalysis, and reprocessing of failed transactions. o Support incident, problem, and change management activities, ensuring timely resolutionand effective communication with business stakeholders. o Provide post-go-live and production support, including defect resolution, system monitoring, and continuous improvement initiatives.
• Systems Integration
Qualifications
Education • Bachelor’s degree in ComputerScience, Information Technology, Business Administration, or a related field.
Certification • SAP Certified Technology Associate - SAP System Administration • SAP Certified Technology Associate - SAP HANA Administration (advantageous) • SAP Certified Technology Associate - SAP S/4HANA System Administration (advantageous) • Relevant cloud certifications (AWS, Microsoft Azure, or Goofle Cloud Platform) are advantageous
