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 Ø Be responsible for designing, implementing, and supporting the integration of SAP Claims Management with related SAP applications to ensure seamless end-to-end business processes, accurate financial reporting, and efficient data exchange across the insurance claims lifecycle. o Implementand maintain integration between SAP Claims Management, SAP FS-CD (Collectionsand Disbursements), FS-PM (Policy Management), and SAP S/4HANA Finance,ensuring accurate reporting and timely data flow across the claims value chain. o Monitor, troubleshoot, and resolve integration issues to maintain data integrity andsystem reliability. o Collaboratewith technical teams and business stakeholders to support interfaceenhancements and integration improvements.
• Documentation Ø Develop and maintain comprehensive functional documentation, including: o Functiona lSpecification Documents (FSD). o Business Requirement Documents (BRD). o Configuration documentation. o Training materials. o Test scripts and execution evidence. o Knowledge transfer documentation.
• Testing and Validation Ø Be responsible for planning, coordinating, and executing testing activities toensure SAP Claims Management solutions, enhancements, and integrations meetbusiness requirements, quality standards, and operational expectations. o Execute unit, system integration, regression, and user acceptance testing activities. o Ensure configured solutions, enhancements, and interfaces perform as intended. o Facilitate and support User Acceptance Testing (UAT) to validate business requirements andprocess outcomes. o Supportdefect management and testing sign-off processes.
• Training, Mentoring and Knowledge Transfer Ø Be responsible for developing team capability by mentoring junior consultants, facilitating knowledge transfer, and promoting continuous learning tostrengthen SAP Claims Management expertise across the organisation. o Mentor andsupport junior consultants and team members. o Conduct knowledge transfer sessions and end-usertraining workshops. o Contributeto building internal SAP Claims Management capability within ZimeleTechnologies.
Qualifications
Education • Bachelor’s Degree in Computer Science,Information Technology, Business Administration, or a related field.
Certification • SAP Certified ApplicationAssociate – SAP for Insurance • SAP Certified ApplicationAssociate - SAP FS-CD (Collections and Disbursements) (advantageous) • Insurance industry orclaims-handling certifications (advantageous)
Experience
• Provenexperience as an SAP Claims Management Consultant, including successful SAPFS-CM implementation, enhancement, and support projects. • Demonstrated expertise in end-to-end claims lifecycle management, including FNOL, reservemanagement, adjudication, payment processing, recoveries, and subrogation. • Strong experience in Workers' Compensation Claims Management processes. • Experiencesupporting claim benefit calculations and complex claims processing scenarios. • Experiencewith SAP ECC and S/4HANA implementations, conversions, or upgrades involving SAP Claims Management. • Experience supporting SAP Fiori applications related to SAP Claims Management, including functional testing, issue analysis, user acceptance testing (UAT), defectresolution, and collaboration with SAP Fiori developers to deliver business requirements. • Experience integrating SAP Claims Management with SAP FS-CD, SAP FS-PM, FI, and CO modules. • Experience supporting and troubleshooting SAP integration technologies, including IDocsand interface monitoring. • Experience integrating SAP solutions with external systems such as claims administrators,medical service providers, repair service providers, and third-party dataproviders.
Knowledge & Skills Required
Ø Technical Skills • Expert knowledge of SAP Claims Management (FS-CM) configuration and business process design. • Strong understanding of claims workflows, status profiles, correspondence frameworks, and claims decision management. • Advanced knowledge of Workers' Compensation claims administration and benefit processing. • Strong knowledge of IDoc monitoring, troubleshooting, and error resolution. • Proven experience configuring BRFplus business rules and fraud management controls. • Strong integration experience with SAP FS-CD for claims payment and recovery processes. • Working knowledge of claims reporting, analytics, reserve adequacy reporting, and operational dashboards. • Strong cross-functionalintegration knowledge across SAP FS-PM, FS-CD, FI, and CO. • Exposure to SAP ABAP debugging and enhancement support is advantageous.
Ø Professional Skills • Strong analytical andproblem-solving capabilities with the ability to resolve complex business andsystem issues. • Excellent stakeholder managementand consulting skills. • Strong verbal and written communication skills with the ability to engage business and technicalaudiences. • High attention to detail and commitment to quality. • Strong customer-focused approachand service orientation. • Ability to work independently and collaboratively within cross-functional teams. • Strong documentation andpresentation skills. • Demonstrated ability to mentor junior consultants and transfer knowledge effectively. • Proficiency in English with excellent report-writing and functional specification development skills. • Flexibility to operate in dynamic project environments and manage competing priorities effectively. • Ability to establish andmaintain strong professional relationships with clients, partners, and internalstakeholders
