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Technical Claims Manager

4 weeks ago

Sandton, South Africa Guardrisk Full time

**Introduction**
- Responsible for the oversight and monitoring of the Guardrisk Group claims management. Strategic and effective management of the technical aspect the claims operations within Guardrisk Group across all insurance lines. Review, direct, and provide accurate, reliable and sound legal and technical claims related support across the business and demonstrate extensive knowledge of the insurance industry standards and provide.**Role Purpose**
- Responsible for the oversight and monitoring of the Guardrisk Group claims management. Strategic and effective management of the technical aspect the claims operations within Guardrisk Group across all insurance lines. Review, direct, and provide accurate, reliable and sound legal and technical claims related support across the business and demonstrate extensive knowledge of the insurance industry standards and provide.**Requirements**:

- LLB Degree
- Comfortable with Insurance Systems
- RE exams for representatives
- Management Courses
- Completed RE Exam
- Registered FAIS Representative
- Minimum Higher Certificate in Insurance
- At least 6 years of commercial and corporate claims experience in an insurer environment
- At least 2 years claims managerial experience
- Sound commercial, corporate and assets insurance technical experience with a proven track record

**Duties & Responsibilities**
- Providing the required technical claims advice for contentious and high value claims to stakeholders as per the binders entered by business
- Monitoring and oversight on the management of claims operations on the cells captive business
- Reviewing and approving Repudiations, Representations, Goodwill payments and Large Losses from the cells/administrators
- Reporting and feedback to business at various management platforms
- Tracking and management of the regulatory complaints from the different Ombudsman and/ or regulator bodies
- Oversee and attending to Due Diligence processes, operational meetings with internal and external stakeholders as well as claims reviews
- Attending to escalations/referrals and providing assurance to the cells/administrators as and when required
- Reviewing and providing final decisions on disputes via arbitration process
- Ensuring regulatory compliance in terms of the claims portion to the cells/administrator
- Managing, planning, and budgeting for the team
- Providing strategic guidance and alignment between Guardrisk and the cells/administrators in relation to claims management
- Liaise with attorneys, loss adjusters, assessors, and investigators
- Effectively manage people, process, and technology e.g. staff development and performance management, succession planning, transformation
- Ensure mandate is set and adhered to by binder holders and brokers
- Provide technical advice on large complex claims
- Manage the responses to OSTI complaints within agreed SLA
- Ensure reviews are conducted as and when required
- Provide technical support to GGI Divisions and UMAs etc
- Oversight and implementation of technical expertise within GGI space
- Implementation of the Claims regulatory requirements, regulations and legal requirements
- Attending operational meetings and preparation of reports
- Coordination of the monthly Ops meeting (Internal and external stakeholders)
- Broker liaison and relationship management
- Embed a client centric approach within all Guardrisk Operations
- Ensure that all claims processes are TCF compliant on a daily basis

**Competencies**
- Good interpersonal skills
- Negotiation skills
- Management Skills
- Excellent communication skills
- Attention to Detail
- Ability to work under pressure
- Decision making skills
- Talent enablement

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