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Job Description

Plan for, implement and manage the Claims Strategic Plan within designated area

Ensuring daily settlements are processed

Ensuring monthly estimates are reviewed

Ensuring recoveries and salvage monies due are received

Effectively manage the use of the Specialty Claims Policy, to facilitate evidence-based decision-making primarily within, but not limited to, the claims area based on best practice and promoting excellent service within mandated area of responsibility.

Review/produce Business reports

Ensure continuous improvement on Standard Operating Process

Benchmark Specialty Claims to market best practice

Estimate audits, claims mandate audit is completed and corrective action is taken

Monitor, track and update the claims division strategy to ensure execution and delivery.

Design, manage and implement a Claims risk Strategy.

Perform risk identification and risk evaluation/ assessment activity on risks at strategic, operational and process level.

Oversee the delivery of the strategic projects and savings.

Review claims best practice across all areas by doing the necessary industry research.

Oversee monitor and track all issues arising from Internal and External Audits to ensure all management actions are implemented.

Ensure complete and accurate management information is provided to all key Claims stakeholders and adequate monitoring mechanisms are designed/implemented to ensure timeous action is taken.

Provide the relevant Reporting for the claims division weekly, monthly and quarterly as required.

Conduct proactive Data analysis to identify trends, concerns and issues. Ensure that all information needs are determined, and enhancements are implemented to align with strategic objectives.

Oversee the claims division communication internally and externally

Oversee and Monitor Claims complaints, client, and broker surveys

Best-practice Service Delivery

Actively implement and monitor service practices to determine the status of customer service and relation

Proactively identify and implement changes required in customer service and relations

Develop customer solutions (process. products and systems) to address changing service requirements, implement customer centric strategies and ensure customer satisfaction

Manage effective SLA’s with internal and external stakeholders

Provide professional services: where expectations are managed

Continuous improvement to ensure optimization and best practice

Streamline and integrate existing business processes and systems

Keep up to date with Best Operating Practice

Identify, prioritise, develop business cases for, present and execute Best Operating Practices

Create collaborative relationships with other departments to determine internal and external process improvements designed to enhance the customer experience and value

Optimise departmental performance through targeted business intelligence to ensure that it becomes the primary way of driving performance and execution

Evaluate and implement new systems and best operating practices

Best-practice people practices

Demonstrate direct leadership – be on the “office floor” frequently enough for personal contact to be real and significant, and to provide a role model to the team

Empower emerging leaders and specialists to achieve technical excellence and innovation

Define and benchmark competitive performance measures

Create an aligned balanced scorecard of operational measures in order to optimally mange performance

Ensure the department, section or specialist function is adequately resourced and has recruitment, retention and HR development plans in place

Ensure that all the team members consistently discharge their duties

Implement and manage a Development plan that ensures that the department has the human resources and skills required to deliver on the strategy for the short, medium, and long term

Identify, attract, appoint, grow, engage, reward, and retain top talent to drive operational execution

Manage poor performance constructively and decisively

Demonstrate leadership behaviour of personal involvement, commitment, and dedication to the business area in support of the organisations culture

Communicate a meaningful operational context to apply people best practice, fostering an environment of continuous learning and improvement

Identify, define, communicate, and obtain buy-in for performance expectations through the implementation of the chosen Old Mutual Insure performance management system

Ensure mechanisms are implemented to support major changes to the function by acting as a change agent

Create a collaborative environment which allows for employees with a functional area to work together, thereby leveraging constructive team dynamics and innovation

Ensure the work environment enables employees to “live” the organisations culture and values

Actively participate in own professional development and career path

Experience, Knowledge & Skills Required:

Relevant degree in business and/ or finance

Fellowship/ Associateship with the IISA or FCIISA preferred

Management qualification an advantage

5 Years relevant experience of which at least 3 years should have been in a management capacity/ leadership role 

Ensures that general insurance claims are handled expeditiously and in a professional manner thereby meeting the customer expectations. Manages the claims function with a team of claims assessors and negotiators. Develops the claims policy, procedures, and practices. Evaluates risks with claims, coverage complexity, and those in excess of field approval limits. Provides counsel regarding claims evaluation and coverage.

ResponsibilitiesInsurance Claims Evaluation

Investigate the circumstances of complex, high-value claims and the nature and extent of clients' losses. Review and evaluate information gathered using own expertise, and examine additional evidence provided by specialist investigators or subject-matter experts to determine the extent of liability. Negotiate settlement of insured losses in line with delegated authority.

Insurance Claims Administration

Review and analyze very complex, high-value insurance claims in line with the organization's claims policies, procedures, and customer service standards. Initiate specialist investigations and engage loss adjusters and/or subject-matter experts where appropriate. Authorize claims within delegated authority and refer complex or unresolved issues to line manager.

Fraud/Financial Crime Management

Develop and deliver specialized fraud prevention and monitoring activities for an area of operations, in line with the organization's fraud management policies and procedures, to enable the prevention of fraud and enable the initiation of loss mitigations and fraud investigations.

Fraud/Financial Crime Investigation

Investigate cases of suspected fraud or financial crime. Identify lines of inquiry, and gather and retain information and physical or electronic evidence to support criminal investigation and/or legal action, engaging specialist investigators or subject-matter experts where necessary. Review the evidence gathered and recommend appropriate action to the organization.

Fraud/Financial Crime-Management Systems Development

Research and identify fraud trends and emerging risks, contribute to the drafting of fraud prevention policies and procedures, and identify opportunities for new and/or improved anti-fraud systems functionalities to support the development of fraud/financial crime prevention strategies, policies, procedures, and monitoring systems.

Leadership and Direction

Communicate the local action plan; explain how this relates to the function's strategy and action plan and to the broader organization's mission and vision; motivate people to achieve local business goals.

Work Scheduling and Allocation

Develop short- or medium-term work schedules in order to achieve planned commitments. Approve overtime or use additional resources as needed.

Financial Policies, Guidelines, and Protocols

Develop and deliver financial guidelines and protocols to ensure the company complies with regulations and good financial practice.

Performance Management

Develop and propose own performance objectives; take appropriate actions to ensure achievement of agreed objectives, using the organization's performance management systems to improve personal performance. Or manage and report on team performance; set appropriate performance objectives for direct reports or project/account team members and hold people accountable for achieving them, taking appropriate corrective action where necessary to ensure the achievement of team/personal objectives.

Solutions Analysis

Analyze specific problems and issues to find the best solutions. Solutions could be technical or professional in nature.

Regulatory and Compliance Management

Investigate all kinds of incidents and reports and provide expert advice to more senior colleagues. Minimize risk exposures and ensure adherence with regulatory standards by working with all internal functions to make sure compliance programs are properly implemented.

Organizational Capability Building

Use the organization's formal development framework to identify the team's individual development needs. Plan and implement actions to build their capabilities. Provide training or coaching to others throughout the organization in own area of expertise to enable others to improve performance and fulfill personal potential.

Skills

Action Planning, Claims Management, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Policies & Procedures, Typology

Competencies

Business InsightCollaboratesCommunicates EffectivelyDecision QualityDirects WorkEnsures AccountabilityFinancial AcumenInstills Trust

Education

NQF Level 7 - Degree, Advance Diploma or Postgraduate Certificate or equivalent

Closing Date

24 March 2025 , 23:59

The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.

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