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Job Description

Purpose of the Job

The role is responsible for the management and functioning of the claims area to achieve high quality claims management and resolution. Drive the containment of claims spend and provide excellent client service in setting a culture of best practice within the mandated responsibility.

Critical objectives and responsibilities

Responsible for the management and functioning of the claims area in order to achieve high quality claims management and resolution.

Continuous Improvement to ensure effective service.

Service Delivery to ensure Customer Satisfaction.

Cost Control and Governance Adherence

Quality People Practice

Experience, knowledge & skills required

Minimum of 5-10 years in leading a Short-term insurance Claims Team

Minimum of 5-10 years’ experience in the handling of Non-Motor related claims

Bachelor’s degree and/or equivalent qualification in management will be advantageous.

The Recruitment process:

TA Interview: This will be a discussion with a member of the TA Team to give you an understanding of our business, our culture & values and more context on the role. It will also allow up the opportunity to get to know you a little better, and ensure OMI can meet your needs

Panel Interview: This will be with 2 members of the senior leadership of the data team and 1 member of the HC leadership team

Technical & Psychometric Assessments: These will depend on the role and will sometimes happen concurrently with MIE & Internal Verification

Final Feedback

All About OMI:

https://www.oldmutual.co.za/about/old-mutual-insure/

https://www.linkedin.com/posts/old-mutual-insure_i-work-at-old-mutual-insure-of-course-activity-7161674472469524483-w0j6?utm_source=share&utm_medium=member_desktop

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 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-Management Systems Development

Identify new and emerging fraud risk factors, draft key elements of fraud prevention policies and procedures, and propose new and/or improved anti-fraud systems functionalities to enable the organization to prevent fraud/financial crime, detect and investigate suspicious activity, and mitigate the risks of losses or reputational harm.

Fraud/Financial Crime Investigation

Investigate complex cases of suspected fraud or financial crime. Identify lines of inquiry, and gather and retain information and physical or electronic evidence that enables 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.

Leadership and Direction

Communicate the actions needed to implement the function's strategy and business plan within the team; explain the relationship to the broader organization's mission, vision, and values; motivate people to commit to these and to do extraordinary things to achieve local business goals.

Performance Management

Manage and report on the performance of a substantial, diverse team; set appropriate performance objectives for direct reports or project/account team members and hold individuals accountable for achieving them; take appropriate corrective action where necessary to ensure the achievement of team/personal objectives.

Budgeting

Deliver a budget for an area of the organization or conduct complex analyses on budget progress in other areas of the organization.

Solutions Analysis

Identify and evaluate complex, expertise-led solutions against a range of criteria to find the ones that best meet business needs.

Regulatory and Compliance Management

Help design and implement a compliance program, liaising with the regulator to ensure the program adheres to regulatory and compliance standards. This may also involve supervising the activities of a regulatory/compliance team.

Financial Policies, Guidelines, and Protocols

Create a plan to deliver and review financial policies, guidelines, and protocols to ensure the company complies with regulations and good financial practice.

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

Accounting, Action Planning, Claims Management, Current State Assessment, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Policies & Procedures, Typology

Competencies

Builds Effective TeamsBusiness InsightCollaboratesCommunicates EffectivelyDecision QualityFinancial AcumenInstills TrustManages Complexity

Education

NQF Level 9 – Masters

Closing Date

03 April 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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