Head Of Claims

2 days ago
Pretoria, South Africa Belmar Personnel Full-time

Introduction

The Head of Claims will lead and manage the end-to-end claims function, ensuring efficient, compliant and customer-focused claims handling. The role is accountable for insurer mandates, binder agreements, operational performance, governance and regulatory compliance while contributing to broader business strategy.

Duties & Responsibilities

  • Develop and execute the claims strategy in line with business and insurer objectives.
  • Lead and motivate claims management teams to achieve operational, quality and customer-service targets.
  • Drive a high-performance culture focused on service excellence, accountability and continuous improvement.
  • Contribute to broader business strategy as a member of the executive leadership team.
  • Maintain the claims standard operating procedure and ensure consistent adherence across the claims function, including required use of workflow and policy administration systems.
  • Maintain an unanswered-call ratio below 3% and manage claims complaints within the approved annual ratio.
  • Oversee escalations from advisers, clients, insurers and other value-chain partners.
  • Maintain average service-level agreement adherence of 95% and keep team rework at no more than 3% of total claims.
  • Ensure the quality assurance function completes required reviews and that findings improve operational performance.
  • Ensure Claims Managers and Team Leaders conduct quality checks and improve employee performance and claim outcomes.
  • Manage insurer and value-chain partner relationships, ensure binder adherence and assist with binder and related audits.
  • Develop and implement strategies that improve operational performance, profitability and customer satisfaction.
  • Maintain and report on strategic, operational and tactical plans.
  • Oversee the logging, classification and resolution of complaint tickets and provide weekly governance and project reporting.
  • Monitor claims performance against binder agreements, insurer mandates and service-level agreements.
  • Report on claims trends, loss ratios, leakage, customer outcomes and operational performance.
  • Maintain strong claims controls and governance frameworks.
  • Manage fraud detection, investigation and prevention initiatives.
  • Oversee audit findings and ensure corrective actions are implemented.
     

 

Desired Experience & Qualification

  • Bachelor’s degree.
  • At least 10 years of relevant experience, including proven senior management experience.
  • FAIS and Regulatory Examination compliance, including RE1 and RE5.
  • Key Individual experience and the ability to be appointed as a Key Individual for the business.
  • Proven experience managing a claims environment within the South African short-term insurance sector.
  • Deep understanding of the South African insurance market, insurer mandates and the outsourced or binder environment.
  • Proven record of driving financial and operational performance within a division.
  • Proven experience engaging with advisers, clients, insurers and related value-chain partners.
  • Policy administration system experience and a solid understanding of insurance systems.
  • Analytical capability with exposure to business intelligence tools.
  • Experience delivering automation, process optimisation or operational improvement initiatives.

Excellent leadership, communication and problem-solving skills

Package & Remuneration

R900 – R1.1 million

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