Maintain relevance of the STA Claims SOP by applying regular updates
Ensure adherence to STA Claims SOP by Claims area (way of work, process adherence, JIRA usage, policy admin system usage)
Ensure that the ratio of unanswered calls / total calls is less than 3%
Claims complaints to be managed within budgeted ratio for financial year (e.g. 15 per 1000 claims)
Oversight/management/handling of escalations from Advisers, clients and associated value chain parties
Ensure SLA Adherence - Average 95%
Number of Reworks / Total number of claims - Not more than 3% - Team Average
Ensure that QA function executes tasks as required and that results are leveraged to improve operational performance
Ensure that Claims Manager/Team Leaders perform quality checks and drive improvement of employee quality/quality claims outcomes
Manage Insurer and value chain partner relationships
Ensure binder adherence
Assist with Binder and other audits
Develop and implement strategies that align with the company's broader goals and contribute to increased operational performance, profitability, and customer satisfaction
Maintain and report on strategic, operational and tactical plans
Oversight of complaints tickets logged, classification, management of execution, ticket governance reporting (Weekly), Group PMO pack reporting (weekly)
Key leadership requirements
Develop and execute the claims strategy aligned to business and insurer objectives.
Lead and motivate claims management teams to achieve operational and customer service targets.
Drive a high-performance culture focused on service excellence and continuous improvement.
Act as a member of the executive leadership team, contributing to broader business strategy.
Binder & Insurer Relationship Management
Manage claims performance against binder agreements and service level agreements.
Build and maintain strong relationships with insurer partners.
Report on claims trends, loss ratios, leakage, customer outcomes, and operational performance.
Ensure adherence to insurer mandates
Governance, Risk Management and Compliance
Ensure compliance with:
FAIS
PPR (Policyholder Protection Rules)
POPIA
Conduct Risk principles
TCF (Treating Customers Fairly)
Applicable insurer mandates and binder regulations
Maintain strong claims controls and governance frameworks.
Manage fraud detection, investigation, and prevention initiatives.
Oversee audit findings and implement corrective actions. (This can be internal audit, risk audits or insurer binder audits)
Minimum requirements:
Bachelor's degree
FAIS and RE compliant (RE1/RE5)
KI experience and ability to be added as Key Individual of the business
Proven experience in senior management role
Proven track record of driving financial and operational performance within a division
Experience in managing Claims environments
Analytical capability and exposure to BI tools
Experience in delivering automation and optimization initiatives
Proven track record of interacting with Advisers/clients
Excellent leadership skills
Problem solving skills
Deep understanding of South African insurance market, outsource/binder environment
Policy administration system experience and a solid understanding of how insurance systems work
Experience with workflow systems and experience within a Binder Holder or UMA will be beneficial